To maintain control of cross infection, ensuring that:
» Any infection a Patient does not spread to others.
» Any Patient is not exposed to potential sources of infection in his/her surroundings.
» Others do not bring infection to the Practice.
All clinical staff.
The policy must conform with current legislation, guidance from professional bodies and current body of opinion on good practice.
There is a regular audit of compliance and regular risk assessments. There is a regular update of external guidelines.
The Practice will arrange for the prevention of infection, toxic conditions or spread of infection in the establishment.
The premises will be kept clean, hygienic and free from offensive odours throughout.
Hand washing facilities will be provided wherever infected materials and/or clinical waste are handled. Hand hygiene guidelines are posted at the hand washing areas, and staff receive training.
Rooms, where infected materials and/or clinical waste are handled, will have impermeable floor finishes and readily cleanable wall finishes.
Employees known to have an infectious condition must not be allowed back on duty until medical clearance is given.
Employees known to have an infectious condition will be reported to the relevant authorities if appropriate. Clinical Waste will be disposed of using appropriate equipment and methods.
There is regular staff training in procedures.
Incident recording takes place in accordance with the Risk Management Policy and Procedure. There is a positive response to concerns raised by Patients regarding Infection Control.
Cross infection control – Statutory procedures and guidance – compliance is checked with the Practice Audit Tool, as based on current national guidance.
There is a Personal Protective Equipment (PPE) Policy and Procedure. There is a Practice Latex Policy and Procedure.
There is a Legionella Policy and Procedure.
Since 1987, the term “universal precautions”has been in use, but now more commonly referred to as either “standard precautions” or “standard infection control precautions”. These have come to explain those interventions made by all healthcare workers when they come into contact with blood and bodily fluids from a Patient.
The aim is to protect themselves and their Patients, from potentially dangerous infections emanating from either blood or bodily fluids, as they may contain viruses or other pathogens. Consequently, a practice must consider that all Patients are considered a risk for cross infection and that a standard system of infection control precautions must be put into place and followed by all Practice staff.
Causes of Infection:
» Bacteria – Unicellular microorganisms, some of which are susceptible (to varying degrees) to antibiotics.
» Worms – Not always microscopic in size, but pathogenic worms do cause infection and can spread from person to person.
» Viruses – Smaller than bacteria, but not susceptible to antibiotics. A few anti-viral drugs are active against some viruses. They grow inside the cells of the body and can survive outside the body for a limited amount of time.
» Pathogenic Fungi – Can be either moulds or yeast. A common example of a mould would be Trichophyton rubrum, which can be a cause of ringworm. A common example of a yeast is thrush, caused by Candida albicans.
» Prions – Infectious misfolded protein particles, such as the prion causing (New) Variant Creutzfeldt-Jakob Disease, a degenerative neurological disorder.
» Protozoa – Microscopic organisms larger than bacteria. Free-living and non-pathogenic protozoa include amoebae and paramecium. A good example would be Giardia Iamblia which can cause symptoms of diarrhoea.
The Service Provider is responsible for updating the Policy as and when changes to legislation occur. The Policy must be checked annually for compliance.
A Risk Assessment of Infection control risks must be carried out regularly by the Safety Officer as defined in the Risk Management Policy and Procedure. Reports of problems concerning infection control issues, as raised by staff, Patients or visitors, must be entered in the Risk Register.
The Health Services and Public Health Act 1968, the Public Health (Infectious Diseases) Regulations 1988 and subsequent amendments require certain infectious diseases to be notified to the ‘proper officer’ of the Local Authority.
The responsibility for the notification of the listed disease(s) rests with the Clinician attending the Patient. The Local Authority has the power to stop work in order to prevent the spread of infection.
Diseases notifiable under the Public Health (Control of Disease) Act 1984: Cholera, Plague, Smallpox, Relapsing Fever, Typhus, and Food Poisoning.
Diseases notifiable under the Public Health (Infectious Diseases) Regulations 1988: Acute encephalitis, acute poliomyelitis, anthrax, diphtheria, dysentery, leprosy, leptospirosis, malaria, measles, meningitis, meningococcal, septicaemia, mumps, ophthalmia, neonatorum, paratyphoid fever, rabies, rubella, scarlet fever, tetanus, tuberculosis, typhoid fever, viral haemorrhagic fever, viral hepatitis, whooping cough and yellow fever.
Most outbreaks will present non-specific symptoms; serious sepsis or epidemic wound infections.
Any member of staff suspecting an outbreak of the notifiable disease should make their suspicions known to the Registered Manager who will inform the Registered Provider and “proper officer” of the Local Authority.
General Rules to prevent the spread of infection
All staff should adhere to the following:
» Avoid infection by careful control of coughing and sneezing, i.e. use tissues/handkerchief;
» Hand washing procedure as published below;
» PPE as detailed in the Personal Protective Equipment (PPE) Policy and Procedure;
» Removal of jewellery and watches;
» Keep hair short or tied back;
» Wear clean uniform clothing, and do not travel to and from work in that clothing. Long sleeved gowns/uniforms should be avoided as they are more likely to lead to contamination. Short sleeved gowns/uniforms are more suitable, allowing the forearms to be washed as part of the hand washing routine;
» Report any signs of infection to the appropriate person;
» Keep toilets scrupulously clean using correct disinfectant agents.
Where Minor Surgery is performed as part of the Registered Activities – Including any invasive procedure, such as taking blood, and inoculation:
» Ensure that the surgery design has washbasins, which should have elbow or foot-operated taps and liquid soap dispensers.
» The operator’s area must have access to instrument tables and operating light. The nurse’s area will contain the suction lines, all cabinetry containing materials and a designated area for clinical waste disposal and the decontamination of instruments.
» Decontamination of instruments as detailed below.
» All instruments, whether used for treatment or not, should be considered contaminated and therefore cleaned and sterilised following usage. Follow all instructions issued by the manufacturer on the decontamination process.
» Clean and dirty areas within the surgical area must be clearly defined.
» The surgical area should be well ventilated.
» Floor coverings should be impervious and non-slip. Carpeting must not be used.
» Work surfaces should impervious and easy to clean and disinfect.
» All water lines and gas lines should be fitted with anti-retraction valves to help prevent contamination of the lines.
» All waste within the practice should be segregated into clinical and non-clinical waste, with the relevant procedures followed at all times.
» Blood spillages should be dealt with immediately.
» All clinical staff should be vaccinated against common illnesses. All staff involved in clinical procedures must be vaccinated against Hepatitis B.
Staff skin awareness
All cuts and abrasions should be covered with a waterproof adhesive dressing. Early detection and prompt reporting of infection is particularly important.
Any staff member with a skin infection must take advice from a doctor before continuing to work. All skin infections must be reported to the Registered Manager.
Staff with diarrhoea and vomiting should not attend work but ring to report sick. Should the condition persist it may be necessary to provide a specimen of faeces and not return to work until medical clearance by a GP is given. It cannot be emphasised strongly enough that young children and the elderly are particularly vulnerable to infection, and every attempt should be made to minimise any risk of infection.
Report to your manager any Patients who have a rash or unaccountable marks on his/her body.
Any Patient may be a carrier of a blood-borne virus. There are blood-borne viruses other than hepatitis B and HIV/AIDS. Appropriate precautions must, therefore, be taken with all Patients and particularly with body fluids.
Always assume that blood and other body fluids are infected. All accidents, facial, particularly eye, or wound contact with infected body fluids must be recorded as an incident.
Accident avoidance measures should include common sense precautions to avoid accidents and injuries, particularly when using sharps, whether the Patient is known to be infected or not. All accidents must be reported.
Blood spillage procedure should be as follows:
» Cover the blood spillage with disposable towels, which are then treated with 10,000 ppm sodium hypochlorite solution or by sodium dichloroisocyanurate granules.
» Allow at least 5 minutes to pass before clearing away the paper towels. Dispose of as clinical waste.
» The healthcare worker who deals with the spillage must wear appropriate protective clothing, including household gloves, protective eyewear and a disposable apron. In cases of extensive floor spillage, protective footwear.
» Good ventilation is necessary.
Hand hygiene guidelines are posted at the hand washing areas, and staff receive training.
Hand hygiene (hand-washing, hand antisepsis, or surgical hand antisepsis) substantially reduces potential pathogens on the hands and is considered the single most critical measure for reducing the risk of transmitting organisms to Patients.
Hands must be decontaminated immediately before any direct Patient contact or care, and after any activity or contact that could potentially result in hands becoming contaminated;
Hands that are visibly soiled, or potentially contaminated with dirt or organic material, must be washed with liquid soap and water;
Hands must be decontaminated, preferably with an alcohol-based hand rub unless hands are visibly soiled, between caring for different Patients and between different care activities for the same Patient;
Before regular hand decontamination begins, all wrist and hand jewellery must be removed. Cuts and abrasions must be covered with waterproof dressings. Fingernails should be kept short, clean and free from nail polish;
An effective handwashing technique involves three stages:
» Preparation – This requires wetting hands under tepid running water before applying liquid soap or an antimicrobial preparation.
» Washing and Rinsing – The handwash solution must come into contact with all of the surfaces of the hand. The hands must be rubbed together vigorously for a minimum of 10-15 seconds, paying particular attention to the tips of the fingers, the thumbs and the areas between the fingers.
» Drying – Hands should be rinsed thoroughly before drying with good quality paper towels.
When decontaminating hands using an alcohol hand rub, hands should be free from dirt and organic material. The hand rub solution must come into contact with all surfaces of the hand. The hand must be rubbed together vigorously, paying particular attention to the tips of the fingers, until the solution has evaporated and the hands are dry.
An emollient hand cream should be applied regularly to protect skin from the drying effects of regular hand decontamination. If a particular soap, antimicrobial hand wash or alcohol product causes skin irritation an occupational health team should be consulted. Avoid petroleum-based lotions, as they can weaken latex gloves and increase permeability. If they are to be used, then it must only be at the end of the day.
Handwashing products, including plain soap and antiseptic products, can become contaminated or support the growth of microorganisms. Liquid products should be stored in closed containers and dispensed from either disposable containers or containers that are washed and dried thoroughly before refilling. Soap should not be added to a partially empty dispenser, because this practice of topping off might lead to bacterial contamination. Store and dispense products according to manufacturer’s directions.
Fingernails, Artificial Nails and Jewellery
Nails should be kept short because the majority of flora on the hands are found under and around the fingernails.
Fingernails should be short enough to allow GP staff to thoroughly clean underneath them, and prevent gloves tears.
Sharp nail edges or broken nails are also likely to increase glove failure. They must, therefore, be checked and cut appropriately.
Long artificial or natural nails can make donning gloves more difficult and can cause gloves to tear more readily. Hand carriage of gram-negative organisms has been determined to be greater among wearers of artificial nails than among non-wearers, both before and after handwashing. They should therefore not be worn, and in the cases of long natural nails, cut.
Freshly applied nail polish on natural nails does not increase the microbial load from periungal skin if fingernails are short; however, chipped nail polish can harbour added bacteria. Therefore check and cut where appropriate.
Rings and decorative nail jewellery can make the donning of gloves difficult and can cause gloves to tear more readily. There is also evidence to suggest that the wearing of jewellery can lead to a substantial risk factor of harbouring germs. They should therefore not be worn by the staff when dealing with Patients. Hand-washing decontamination procedures (as indicated above), must be followed.
Employees known to have an infectious condition must not be allowed back on duty until medical clearance is given. Staff with diarrhoea and vomiting should not attend work but ring to report sick. Return to work may be allowed 48 hours after symptoms cease, however, should the condition persist it may be necessary to provide a specimen of faeces and not return to work until medical clearance by a GP is given.
The Registered Manager is responsible for maintaining contact with staff concerning this and commissioning medical reports should they be necessary. Employees known to have an infectious condition will be reported to the relevant authorities if appropriate.
All cuts and abrasions should be covered with a waterproof plaster (blue coloured if working in food areas). Early detection and prompt reporting of infection is particularly important.
Any staff member with a skin infection must take advice from a doctor before continuing to work. All skin infections must be reported to the Registered Manager.
Clinical Waste will be disposed of using appropriate equipment and methods, as detailed in the Health and Safety Policy and Procedure.
The Practice is compliant with Cross Infection Control Guidance and is checked with the published Audit Tool. Infection control procedures as below.
All staff receive training in relation to:
» The prevention and management of blood-borne virus exposure.
» Risk reduction in blood-borne virus transmission and general infection.
» All decontamination and clinical staff demonstrate current immunisation with the hepatitis B vaccine, documentation lodged with the Practice Manager.
» Chlorine-releasing agents available for blood/bodily fluid spillages and all clinical staff are trained in use as per manufacturers’ instructions.
» Sharps containers available at the point of use and positioned safely.
» Sharps containers are correctly assembled and are labelled with the date, locality and a signature.
» Sharps containers are never filled beyond the indicator mark and are locked with the integral lock when full. When full, they are stored in a secure facility away from public access.
» There are readily-accessible protocols in place that ensures staff are dealt with in accordance with national guidance in the event of blood-borne virus exposure. Inoculation injuries are recorded.
» Disposable needles and disposable syringes discarded as a single unit.
» This policy and procedure include all appropriate aspects of decontamination within the practice e.g. cleaning, disinfection, inspection, packaging, disposal, sterilisation, transport and storage of reusable and single-use instruments. It is kept up to date by the Practice Manager.
» All relevant staff received training for the decontamination procedures which they are expected to perform including correct use of equipment.
» A record is kept of any instruments that cannot be reprocessed in accordance with your local decontamination policy and procedure.
» All wrapped, sterilised instruments are dated with the use-by date.
» The Registered Manager is the nominated lead responsible for infection control and decontamination.
» The registered manager has a written statement of duties with specific reference to equipment validation, which is updated with details of all equipment involved in the clinical areas.
» Transportation of instruments to and from other locations is inclosed, marked, boxes – which ensures the segregation of contaminated instruments from clean/sterilised instruments.
» All logbooks including testing, service, maintenance and repair records are retained in the practice for at least 2 years.
» Disposable instrument trays are used as a standard, but if reusable trays are used, they decontaminated and sterilised after each use.
» All instruments (used or unused) left on trays at the end of each session are decontaminated (washed and sterilised) before further use.
» Instruments that are not decontaminated immediately are kept moist until they are decontaminated.
» All instruments are inspected under an illuminated magnification device for cleanliness and condition following cleaning.
» All instruments are decontaminated between each Patient in accordance with manufacturers’ instructions.
» Separate canisters of lubricant used for unclean, cleaned and sterilised instruments.
» Equipment with moving parts that need to be manually cleaned/wiped are lubricated with oil before steam sterilisation in accordance with manufacturers’ instructions.
» Equipment decontaminated by an automated washer/disinfector is lubricated with oil before steam sterilisation in accordance with manufacturers’ instructions.
» Equipment decontaminated by an automated washer-disinfector with a specific irrigation system, are lubricated with oil before steam sterilisation in accordance with manufacturers’ instructions.
» All other instruments are washed in a washer-disinfector before steam sterilisation.
» When the washer-disinfector is not present, or out of action, all instruments are cleaned (manually or using an ultrasonic cleaner) before steam sterilisation.
» With manual cleaning, two sinks or two bowls in a single sink unit, are used for cleaning – one for washing and a separate one for rinsing.
» Detergents used for manual cleaning are specifically formulated for the purpose of cleaning instruments and are used at the specified concentration according to manufacturers’ guidance.
» The temperature of the water is kept at 45°C or lower, and where the manufacturer’s instructions permit, instruments are fully submerged when cleaned.
» Brushes used to clean instruments are either single-use or washed after each use and replaced at the manufacturers’ recommended interval or when damaged.
» There are contractual arrangements to ensure all steam sterilisers are routinely maintained and validated in accordance with HTM requirements or with manufacturers’ instructions. The Practice Manager has a responsibility to keep contracts current and operational.
» The Practice Manager has responsibility for keeping and maintaining daily, weekly, quarterly and annual inspection, testing and maintenance records for steam sterilisers.
» Steam sterilisers removed from service following an unsatisfactory test result are not used until the fault is rectified.
» There are arrangements to ensure all ultrasonic cleaners are maintained and validated in accordance with Guidelines or with manufacturers’ instructions. Daily, weekly, quarterly and annual inspection, testing and maintenance records are available for ultrasonic cleaners.
» Contractual arrangements are in place to ensure all automated washer-disinfectors are routinely
maintained and validated in line with manufacturers’ instructions. The Practice Manager has a responsibility to keep contracts current and operational.
» Daily, weekly, quarterly and annual validation and testing results are recorded for automated washer- disinfectors.
» Instruments placed in ultrasonic cleaning baths are kept in instrument baskets or cassettes and fully immersed, ensuring that all surfaces are in contact with the solution.
» The lid of the ultrasonic cleaner is closed during cleaning cycles and whilst not in use to prevent contamination of the ultrasonic cleaning solution. The water in the chamber is emptied when visibly contaminated or otherwise at the end of every clinical session.
» Where instruments are manually cleaned, they are rinsed after being ultrasonic cleaned and before sterilisation.
» Are relevant staff are aware of the instrument loading procedure for washer-disinfectors, i.e. spray arms are free to rotate, cannulated instruments are correctly loaded. There is a record made of the date, temperature and pressure achieved and satisfactory completion for each cycle.
» Steam sterilisers are not used if fault lights are displayed.
» Pre-wrapped instruments are placed only in vacuum-type sterilisers.
» Freshly distilled water, sterile water for irrigation or reverse osmosis (RO) water is only used in the steriliser. Opened bottles of sterile or distilled water are discarded at the end of each working day. The reservoir is drained and left clean and dry at the end of each day.
The decontamination area has a zoned workflow from dirty to clean.
» Where possible, there are separate, dedicated decontamination room/s which are restricted to those performing decontamination duties.
» Decontamination areas and work surfaces are clean and uncluttered, and there is adequate ventilation in the clean and dirty room/s to service the washer-disinfector and steriliser.
» Where full mechanical ventilation is used, the direction of air flow is from the clean to dirty area.
» Both clean and dirty instruments are carried inclosed, marked, boxes to ensure the safe transfer of instruments within the Practice. The transport containers are cleaned, disinfected and dried following each use.
» Instruments processed in a non-vacuum (type N) steriliser are dried prior to packing using disposable non-linting cloth.
» The Practice has a system in place to ensure that storage of non-wrapped and wrapped instruments does not exceed: • 21 days for those instruments sterilised in non-vacuum sterilisers (type N); or • 60 days if sterilised in a validated type B vacuum steriliser or in a cassette following sterilisation in a validated type S steriliser.
» Wrapped instruments are stored away from the clinical environment and used in strict rotation. Each instrument is labelled to identify storage time, including the date by which they should be used or reprocessed.
» Instruments are stored in a dedicated, secure, dry and cool environment, which is regularly cleaning and maintaining. Staff undertaking cleaning duties have been fully trained to undertake such duties.
» The overall appearance of the clinical and decontamination environment is tidy and uncluttered.
» The surgical coach, bed or chair is cleaned between each Patient and is free from rips or tears.
» All surfaces (i.e. walls, floors, ceilings, fixtures and fittings, and chairs) are free from damage and abrasion. All work-surface joints are intact and seamless with no visible damage. All surfaces (i.e. walls, floors, ceilings, fixtures and fittings, and chairs) are free from dust and visible dirt.
» The surfaces of accessible ventilation fittings/grills are cleaned weekly.
» All surfaces in clinical and decontamination areas are impervious and easy to clean.
» Keyboard covers or “easy-clean” waterproof keyboards are used in clinical areas.
» No rooms where clinical practice takes place are carpeted.
» All floor coverings in clinical and decontamination areas have coved edges that are sealed and impervious to moisture.
» Records of cleaning maintained in accordance with the HCAI Code of Practice. Cleaning equipment is colour-coded in accordance with the National Patient Safety Agency’s recommendations. Cleaning equipment is stored in a non-clinical area.
» Where disposable single-use covers are used, they discarded after each Patient contact.
» The surfaces of equipment and furniture are cleaned between each Patient (for example, work surfaces, chairs, examination instruments, delivery units, inspection handles and lights, spittoons, external surfaces of any drawers or furniture which may be touched) and protected with disposable covers.
» All taps, drainage points, splashbacks, sinks, aspirators and drains are cleaned after every session with a surfactant/detergent.
» All floors, cupboard doors and accessible high-level surfaces are cleaned daily.
» There is a designated area for the disposal of dirty water, which is outside the kitchen, clinical and decontamination areas, for example, toilet, drain, slop-hopper (a device used for the disposal of liquid or solid waste) to reduce the risk of contamination of a public or staff toilet.
» The Practice has a local policy and procedure for spillages in accordance with COSHH – see Health and Safety Policy and Procedure.
» The practice has a local policy and procedure for hand hygiene.
» The practice has an infection control policy and procedure that includes procedures for the use, maintenance, service and repair of all medical devices – see Equipment Safety Policy and Procedure.
» The Practice Manager is nominated for responsibility and authority to ensure that all staff comply with the medical device procedure.
» The practice has carried out a risk assessment for legionella under the Health & Safety Commission’s “Legionnaires’ disease – the control of legionella bacteria in water systems: Approved Code of Practice & Guidance” (also known as L8). There is a written scheme for prevention of legionella contamination in water pipes and other water lines.
» All new reusable instruments are decontaminated prior to use.
» Contaminated medical devices are decontaminated and inspected prior to inspection, maintenance and repair.
» Instruments sent for repair are labelled to identify that they have been through the decontamination process.
» Single-use instruments are never reprocessed.
» Scalpel blades, or any instrument coming in contact with connective tissue, are single-use.
» Prosthetic appliances are decontaminated before being placed on or in the Patient.
» All difficult-to-clean instruments/devices are identified in a risk assessment process and treated as single- use.
» There is an independent bottled-water, or bagged saline, system used to dispense fresh sterile fluids to supply any equipment requiring constant irrigation, these are drained down at the end of every working day.
» For surgical procedures involving irrigation, a separate single-use sterile water or saline source is used for irrigation.
» Self-contained fluid dispensers are removed, flushed with distilled or clean water and left open to the air for drying on a daily basis and if necessary overnight, and in accordance with manufacturers’ guidance.
» Where bottled water systems are not used, there is a physical air gap separating equipment from mains water systems (Type A).
» Equipment is flushed for 2 minutes at the start of each working day and for 20–30 seconds between every Patient.
» All fluid based equipment is fitted with anti-retraction valves.
» Fluid filters are changed according to the manufacturers’ guidelines.
» Inhalation oxygen machines and breathing systems (tubing, masks, nasal hood and nose pieces) are used in accordance with manufacturers’ or suppliers’ instructions. ISM flowmeters are used and maintained in accordance with original equipment manufacturers’ or suppliers’ instructions.