Drs Preston and Austin - Infection Prevention and Control Policy. Review Due Feb 2016

INFECTION PREVENTION AND CONTROL

INTRODUCTION

Policy Statement

The practice will be vigilant in the enforcement of the following procedures for the prevention and control of infection. All staff including clinicians and cleaning will receive training in infection control aspects.

This practice is committed to the control of infection within the building and in relation to the clinical procedures carried out within it.

The practice will undertake to maintain the premises, equipment, drugs and procedures to the highest standards and will undertake to provide facilities and the financial resources to ensure that all reasonable steps are taken to reduce or remove all infection risk.

Wherever possible or practicable the practice will seek to use washable or disposable materials for items such as soft furnishings and consumables, e.g. seating materials, wall coverings including paint, bedding, couch rolls, modesty sheets, bed curtains, floor coverings, towels etc, and ensure that these are laundered, cleaned or changed frequently to minimise risk of infection.

Proposals for the Management of Infection Risk

The clinician responsible for Infection Control is Dr M R Preston

The non-clinician responsible for Infection Control is Rebecca Ross

Rebecca Ross will be responsible for the maintenance of personal protective equipment and the provision of personal cleaning supplies within clinical areas

Rebecca Ross will be responsible for the maintenance of the provision of personal cleaning supplies within non-clinical areas

Rebecca Ross will be responsible for the maintenance of sterile equipment and supplies, and for ensuring that all items remain “in date”

The following general precautions will apply:

•An alternate day cleaning specification will apply and will be followed by the cleaning staff.

•Infection Control training will take place for all staff on an and will include hand washing procedures and sterilisation procedures

•Infection Control Training will take place for all new recruits.

•Hand washing posters will be displayed at each designated hand basin.

Not all healthcare associated infections (HCAI) are avoidable. Howevera significant proportion can be prevented by the adoption of evidencebased Infection Prevention and Control Standards which must bepracticed consistently by all staff.

These principles of Infection Prevention and Control are required toprevent exposure of staff to infectious agents, including blood and bodilyfluids and also protecting patients/service users from cross infection.

The Health Act (2006): Code of Practice for the Prevention and Controlof Healthcare Associated Infections (HCAI) states:

“NHS organisations must ensure, so far as is reasonably practicable, patients, staff and other persons are protected against the risks ofacquiring a HCAI, through the provision of appropriate care in suitablefacilities consistent with good clinical practice”.

National Guidance including The Prevention of Healthcare Associated Infections in Primary and Community Care, (National Institute for ClinicalExcellence (NICE) 2003) and Epic2: National evidence-based guidelinesfor preventing healthcare associated infections in NHS hospitals inEngland (2007) provide the evidence base for the elements of clinicalpractice that are essential for the prevention and control of infections.These measures are referred to as Standard Principles of InfectionPrevention and Control and include:

  • Hand hygiene
  • The safe use and disposal of sharps.
  • The use of personal protective equipment.

All staff working in the Practice should apply thesestandard principles in order to minimise the risk of cross infection totheir patients/service users and to protect themselves and theircolleagues from exposure to any infectious agents.

To ensure their own personal safety, the safety of colleagues, patientsand the general public, staff in General Practice should adhere to the principles contained withinthis procedure.

Purpose

All staff have a professional duty to ensure that they take reasonablesteps to avoid putting the health and safety of others at risk.

This policy sets out the principles of best and safe practices asrecommended in the NICE guidelines (2003) and epic 2 (2007).

The following with be addressed:

  • Hand hygiene
  • Protective clothing
  • Sharps
  • Decontamination of equipment
  • Body fluid spillage
  • Waste handling
  • Sterilisation and equipment cleaning
  • Handling of specimens
  • Fridge cleaning and defrosting
  • Acceptance/purchase of toys
  • Cleaning of toys
  • Needle stick injuries and sharps
  • Reviews of the above.

Hand Hygiene

Hands must be decontaminated immediately before and after each andevery episode of direct patient contact or care and after any activity orcontact that could potentially result in hands becoming contaminated.

Hands that are visibly soiled or potentially contaminated with dirt ororganic material must be washed with soap and water, preferably liquidsoap wherever possible.

Alcohol hand rubs are a practical and acceptable alternative to soapand water when handwashing facilities are inadequate. They must notbe used when hands are visibly soiled.

Hands should be washed with soap and water after 5 consecutiveapplications of hand rub.

Staff should be trained in basic hand hygiene if possible.

Personal Protective Equipment (PPE)

Gloves

Gloves must be worn for invasive procedures, contact with sterile sitesand non intact skin or mucous membranes and all activities that havebeen assessed as carrying a risk of exposure to blood, bodily fluids,secretions and excretions and when handling sharp or contaminatedinstruments.

Gloves must be worn as single use items. They should be put onimmediately before as episode of patient contact or treatment andremoved as soon as the activity has been completed.

Gloves must be changed between caring for different patients or between

different care/treatment activities for the same patient.

Following removal gloves must be disposed of as clinical waste andhands washed ideally with soap and water.

Sensitivity to natural rubber latex (NRL) in patients and staff must bedocumented and alternatives products to NRL used in these situations.

Disposable plastic aprons

Disposable plastic aprons must be worn when close contactwith the patient or equipment is anticipated and where there is a risk thatclothing/uniform may be exposed to pathogenic microorganisms, blood,bodily fluids, secretions or excretions.

Plastic aprons must be worn as single use items, for oneprocedure or oneepisode of patient care and then disposed of as clinicalwaste. Hands must then be washed ideally with soap and water.

Face masks and eye protection

Face masks and eye protection must be worn where there is a risk ofblood, body fluids, secretions or excretions splashing into the face, mouthor eyes.

Safe Use and Disposal of Sharps

Background

Percutaneous injury involving a hollow bore needle (71%) is the mostcommonly reported cause of sharps injuries amongst HCWs but otherdevices which can cause injury include scalpels, stitch cutters, glassampoules and sharp instruments (HPA 2005).

Findings from the HPA study (2005) identified that most accidents occur:

  • During use.
  • After and before disposal.
  • After the procedure and before disposal.
  • During disposal.
  • Whilst re-sheathing. Although this is a practice which should not beundertaken.

SHARPS MANAGEMENT

-Sharps Containers must comply with British Standard 7320, United Nation Standard

3291, or their equivalent, and meet the full specification and colour requirements forsharps containers as dictated in “The Safe management of Healthcare Waste (2012)vol. 2.”

-Ensure containers are correctly and securely assembled (follow manufacturers’instructions).

-Ensure the label is completed fully to identify date of assembly – this also identifiessource and audit trail.

-When not in use (between treatment sessions) containers should be stored with thelid in the ‘temporary closed’ position to prevent spillage of sharps if the container is knocked over.

-Dispose of container when it is three-quarters full – ensure secure closure andlocking, and ensure the label is completed. Sharps bins should never be placed inany waste bags or waste bins.

-Avoid prolonged use of sharps containers – maximum period of use three month.

-Always store in a safe, designated, secure area, ie in a locked area, containersshould never be placed in corridors or areas with access to the general public(Management of Waste16.08), and in compliance with the ‘Safe Management ofHealth Care waste 2012’.

-Ideally the sharps container should be taken to the point of care (unless this isidentified as) a risk to ensure that the sharp is disposed of as soon as possiblefollowing use.

Safety Precautions when Using and Disposing of Sharps:

-The directive 2010/32/EU states that where medical devices provide a risk of sharpsof injury a formal risk assessment should be undertaken by the manager of theservice, the exposure should be eliminated if possible and if unable to be eliminated,the safest type of equipment/medical device should be used.

-The Practice has fully supported the introduction ofsyringe devices, with engineered safety mechanisms to reduce incidents ofneedlestick injuries. Practice staff are expected to use retractable needles or otherdevices with engineered safety mechanisms, to administer injectable medicines.Conventional needles should only be used in exceptional circumstances accordingto medicines management policy19.09

-Each healthcare worker involved in providing care should adhere to handdecontamination and use standard precautions to include the use of gloves andaprons in conjunction with the safe use and disposal of sharps. Protectiveequipment must be based on an assessment of the risk of transmission of micro-organisms and the risk of contamination of the healthcare worker’s skin by patients’blood, bodily fluids, secretions or excretions according to the Infection Preventionand Control policy 18.12

-Select the size of sharps container most appropriate to your needs (this aims toavoid prolonged uses).

-Discard sharps directly into a sharps container immediately after and at the pointof use.

-Do not re-sheath a needle. Dispose of needle and syringe as a complete unit –never detach unit by hand.

-Do not pass sharps directly from hand to hand, or pass to another person –handling should be kept to a minimum. Only the person using the sharps mustdispose of them.

-Sharps containers should be available at the point of use of the sharp – they shouldbe taken to the point of care and be carried by all staff who use sharps as part oftheir work in the community.

-Disposal of Sharps containers to be completed safely in accordance with the HT 07-01: Safe management of healthcare waste (DH 2007 b)

Decontamination of Equipment

Decontamination is a combination of processes (including cleaning, disinfectionand sterilization) used to make a reusable item safe for further use on patients and handling by staff. The effective decontamination of reusable medicaldevices is essential in reducing the risk of transmission of infectious agents.

The practice minimizes any risk of contamination by only using single use or disposable equipment. This equipment is then disposed of in the clinical waste (unless sharp).

Some examples to name but a few of these are single use implant removal kits, single use uterine sounds, disposable noots for ears, disposable spirometry filters, single use disposable minor surgery kits etc.

The practice used to own an autoclave but to reduce risk of contamination to almost zero, this was discontinued. This means that any equipment used in patient contact bar the furniture, is sterile and only used once.

For more information please check the Decontamination Protocol.

Body Fluid Spillage Management

When dealing with Blood and Body Fluid Spillage all staff must wear personalprotective clothing (gloves and aprons) at all times.

All Personal Protective Clothing must be disposed of into Clinical Waste bags.

Further Personal Protective Equipment must be used appropriately when there is a riskof extensive splashing of blood and body fluids e.g. body fluid repellent gowns, facevisors and footwear.

  • Never use mops to clear up body fluid spillages.
  • All body fluid spillage must be cleaned up immediately and effectively.
  • Hypochlorite releasing agents can be a hazard especially if used in large volumes in
  • confined spaces, or mixed with other chemicals or urine.
  • Use the “Clean Up Kit” for Vomit and Urine which is located in Admin next to the Anaphylaxis kit.
  • Wear disposable gloves and aprons.
  • Glove choice must be Nitral or Latex gloves please refer to Guideline on Non-Sterile
  • Examination Glove (Corp/Guid/052). Vinyl gloves are not suitable for use when

dealing with blood and or body fluids.

  • Wounds and lesions on exposed skin should be covered with a waterproof dressing.
  • Ensure adequate ventilation is required when using hazardous chemicals to clean areas.
  • (Ensure windows and doors are open)
  • Splashes of blood or body fluid on to the skin must be washed off immediately with

soap and water.

Please Note: A warning sign must be displayed and clearly visible at all times around the

affected area.

Waste Handling Guidance

The safe disposal of all waste by those involved in the handling, transporting or processing of it isan essential part of health and safety and general good hygiene, and is covered by legislation.The safe disposal of clinical waste particularly when it might be contaminated with blood, otherpotentially infectious body fluids, secretions or excretions (excluding sweat) is one of theelements of Standard Infection Control Precautions. Care of contaminated waste involves manyelements which ensure ultimate safe disposal. Infection prevention and control is one paramountelement.

By disposing of waste safely and appropriately it is intended that the risk of transmittingmicroorganisms , and potential infection, via this route will be avoided or minimised.

Waste produced as a result of healthcare activities is classified as healthcare waste in the

European Waste Catologue . Healthcare waste includes no /minimal risk hygiene waste as wellas items which pose a risk either due to their potentially infectious nature or contamination withpharmaceutical products, these are known as hazardous waste.

Hazardous waste is subject toadditional controls as specified in the Hazardous Waste (England & Wales) Regulations 2005.

When to dispose of waste safely and appropriately:

-Waste should be disposed of as close to the point of use as possible, immediately afteruse.

Where to dispose of waste safely and appropriately:

This guideline should not be read in isolation but in addition to the local Waste Disposal Policy.

-Use identified bag holders particularly in care settings. These should be hands free/pedaloperated lids, hard bodied , containing appropriate waste bags, so that hands do notbecome contaminated during waste disposal e.g. by having to touch lid to open.

-Waste bags/containers used to hold waste should be of an appropriate strenght to ensurethey are capable of containing the waste without spillage or puncture, e.g. UN approved,including:

- UN approved bags which are orange or yellow in colour and indicate hazardoushealthcare waste for treatment/incineration and disposal, should always be usedappropriately depending on the waste being generated.

- Approved sharps containers/boxes should also always be used as they are punctureresistantand retain liquids. These must be assembled correctly, followingmanufacturer’s instructions

- Hygiene waste should also be disposed of into appropriate receptacles.

- Never dispose of waste into an already full receptacle

- Bags should be no more than ¾ full. Sharps bins should be no more than ¾ full /pastmanufacturers fill line.

- Where patients can dispose of their own waste e.g tissues they should be encouraged todo so and provided with appropriate waste receptacles for this e.g leak proof.

How to dispose of waste safely and appropriately:

Always wear personal protective equipment.

Procedures:

- Never touch the waste receptacle itself, e.g the lining of the outside ofbags/containers, while items are being disposed of.

- Never over fill waste receptacles

- Items containing fluid, particularly those containing blood/body fluids, that have to bedisposed of should first have the contents solidified in order that they are safe totransport.

- Seal all bags/containers appropriately before disposal/transporting/processing. Inaccordance with local guidance(e.g bag ties, first using a swan neck tie)

- Tagging of waste in accordance with local policy

- Perform hand hygiene following any waste handling/disposal.

- Transport, store in accordance with local policy

- Manage spillages in line with local policy.

Incident reporting:

Any incident where in appropriate waste disposal has occurred should be reported to the Practice Manager or Infection Control Lead in line with local incident reportingprocedures.

Sterilisation and Equipment Cleaning

The Practice only uses single use disposable equipment and therefore there is no need for sterilization of equipment. This equipment should never be used more than once and should be disposed of in accordance with local guidance in the appropriate clinical waste bins. This keeps risk of infection to an absolute minimum.

For more information please see the Decontamination Policy.

Handling of Specimens

Specimens are usually handed to reception over the front desk. A specimen should only be accepted if there is no evidence of leakage, and the bag is sealed.

The following must be true:

-Specimens are sent to the microbiology laboratory in appropriate containers

-Patients are provided with an appropriate specimen container if required to produce specimens at home

-Specimens are sealed in appropriate plastic transit bags

-Request forms are not in the same part of the transit bag as the specimen

-Bags are not sealed with staples or paper clips

-Specimens awaiting transit are stored away from the public/ staff rest areas

-Refrigeration (for specimens away from food) is available if required

-Samples tested on site are disposed of down a toilet or sluice

-Samples in sealed containers should pose low risk as long as the outside has not beencontaminated or damaged. However, all samples should be handled as little aspossible

-All samples in appropriate containers are to be inserted into the approved plastic

-bag that is sealed

-All blood or potentially infected matter such as urine or faeces for microbiologicalexamination should be treated as high risk and precautions used