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EBPCOOH/CG/IR/MB Rev 10 02/2014 Infection Control & Decontamination Policy

East Berkshire Primary Care

Out of Hours

Infection Control &

Decontamination Policy

EBPCOOH/CG/IR/MB 2 Infection Control & Decontamination Policy

Version Ratified

Name of Originator

Responsible Owner

Next Review Date

9 01/10/2013

Marie Bass

Nurse Lead

10/2014

10 04/02/2014

Nurse Lead

02/2016


Contents

1.Introduction……………………………………..…………………………….……… 5

2. Review of Policy…………………………………………………………………..… 6

3. Duties……………………………………………………………………………….… 6

4. Organisational Framework…………………………………………………..…… 9

4.1 Qualities and Safety Committee……………………………………………… 9

4.2 Clinical Review Group………………………………………………………… 9

4.3 Specialist Infection Control Advice…………………………………………… 9

4.4 Training and Education………………………………………………………… 9

4.5 Occupational Health…………………………………………………….……… 10

4.6 Immunisation Guidance…………………………………………..…………… 10

4.7 Staff Who Cannot Gain Immunity…………………………….….…………… 11

4.8 Hepatitis B Vaccination………………………………………………………… 11

5. Audit and Inspection………………………………………………..……………… 12

6. Monitoring……………………………………………………………………….…… 12

7. Infection Control Training………………………………………………………… 13

8. Background Information………………………………………………………...… 13

8.1 Basic Microbiology - Micro-organisms and their Properties……………..… 13

8.2 The Transmission of Infection………………………………………………… 14

8.3 General Infection Control Considerations…………………………………… 15

8.4 Simple Hygiene……………………………………………………………….… 16

8.5 Hand washing / Hand cleansing……………………………………………… 16

8.6 Hand Washing Technique………………………………………..…………… 16

8.7 Hand Washing Facilities……………………………………………………..… 18

8.8 Use of Alcohol Gel……………………………………………………………… 19

9. Protective Clothing………………………………………………………………… 19

9.1 Gloves…………………………………………………………………………… 19

9.2 Disposable Protective Clothing………………………………….…………… 20

9.3 Face Masks………………………………………………………………..… 20

9.4 What to Wear When…………………………………………………………… 20

9.5 Replenishment of Stocks……………………………………………………… 21

10. Cleaning and Decontamination…………………………………………………..21

10.1 Care of Vehicles…………………………………………….………………… 21

10.2 Cleaning System 1…………………………………………………………… 21

10.3 Cleaning System 2………………………………………………….………… 22

10.4 Cleaning Materials Options Chart…………………………………………… 22

10.5 Equipment Cleaning Guide……………………………………..…………… 23

10.6 Daily Clean…………………………………………………………………..… 24

10.7 GP Visit Vehicle Interior Cleaning – Regular Clean……….……………… 24

10.8 Linen………………………………………………………………………….… 24

10.9 Single use Equipment…………………………………………………….… 25

10.10 Sterile Equipment…………………………………………………………… 25

10.11 Care of Equipment……………………………………………………..…… 25

10.12 Reusable Equipment………………………………………………..……… 25


10.13 Repairs/Servicing…………………………………………………………… 25

11. Decontamination Procedures…………………………………………………… 26

11.1 Spillage Management………………………………………………………… 26

11.2 Spillage Kit…………………………………………………………………..… 26

11.3 Immediate Action……………………………………………………………… 26

11.4 For low risk fluids: Detergent and Water…………………………………… 27

11.5 For higher risk fluids: Disinfection…………………………………………… 27

11.6 Disinfection of premises where patient has been accepted……………… 27

11.7 Disposal of used sharps containers and Clinical WasteB………………...28

11.8 Care of the Deceased…………………………………………………………28

12. Risk Assessment of Medical Devices and other Equipment……………… 28

12.1 New Equipment……………………………………………………………….. 28

12.2 Existing Equipment…………………………………………………………… 28

12.3 Risk Assessment for Decontamination of Equipment…………….……… 29

Appendix 1 - Accountability Line Diagram……………………………………….. 30

Appendix 2 - Management of body fluid spillages………………………..…… 31

Appendix 3 - Management of Human Bites……………………………………….. 32

Appendix 4 - Inoculation Incidents Policy & Procedures…………………..… 33

Introduction…………………………………………………………………..……… 33

Procedure for safe preparation, use, handling and disposal of sharps……….. 34

Information and Training…………………………………………………………… 35

Guidance for Management and Staff on Procedures for Accidental Inoculation with a used needle or other sharp instrument. …………………………….…… 35

Appendix 5 - COSHH Regulations………………………………………………..… 37

Appendix 6 - Needlestick Injury Procedure……………………………………..… 38

Appendix 7 - Example Cleaning Schedule……………………………………… 45

References and Bibliography……………………………………………………..… 46


1. Introduction

This policy and its associated procedures have been developed from the Strategy Framework and the Department of Health’s guidance document “Reducing infection through effective practice in the pre-hospital environment” June 2008; as well as various other Department of Health Healthcare Associated Infections (HCAI) directives. It is intended that this document should be the central source of reference on matters relating to the management of Control of Infection. It is essential that all staff read and fully familiarise themselves with this document. East Berkshire Primary Care Out Of Hours Service’s (EBPCOOH) Infection Control & Decontamination Policy is intended to provide the Council with an effective approach to ensure highest standards of infection control within the Service are met. Consideration is given to the expectations of patients to a clean, modern environment, safe working conditions and best practice being followed by all employees and sub contractors. This policy identifies potential risks arising from infection control and decontamination issues and advice on how they should be managed. The Chief Executive and the Clinical Executive are ultimately responsible for ensuring that the Infection Control & Decontamination Policy and Procedures are implemented. This is

delegated through the Council to the Medical Director and the Clinical Governance Lead. This policy links with other associated Policies in use by the contractor organisations. These are included as appendices or referenced herein. High standards of care are expected throughout the Health and Social care Service. Care should be based upon national standards and monitored through the framework of Clinical Governance. Standards may be related to the policy, procedures and outcomes including provision of high quality facilities and principles of practice. Although the subject of Infection Control and Decontamination is broad and complex, it will be seen that the new procedures largely simplify our approach to this key area. Staff should be reassured that all changes reflect current ‘best practice’ in today’s modern health profession and are subsequently endorsed by Department of Health. The Health Act 2006 (Part 2 – Prevention and Control of Health Care Associated Infections) provides a code of practice, which is designed to: “Make such provision as the Secretary of State considers appropriate for the purpose of safeguarding individuals (whether receiving healthcare of otherwise) from the risk, or any increased risk, or being exposed to health care associated infections or of being made susceptible, or more susceptible, to them”. The Act defines a Health Care Associated Infection as: “Any infection to which an individual may be exposed or made susceptible (or more susceptible) in circumstances where – Health care is being, or has been, provided to that or any other individual, and

(a) The risk of exposure to the infection, or of susceptibility (or increased susceptibility) to it, is directly or indirectly attributable to the provision of the healthcare”.


REMEMBER IT HAS BEEN ESTABLISHED FOR YOUR SAFETY The prevention and control of infection in healthcare settings can cover a wide range of aspects and activities. It is intended that this document will provide a generic framework of best practice for the control of infection across all sectors of EBPCOOH activities, but recognised that there will be a requirement for additional local procedures in some areas. Such local procedures should build on rather than replace the guidelines contained within this document. EBPCOOH is committed to minimising all risks associated with infection control and reducing the impact of healthcare associated infection on patients staff and EBPCOOH overall. EBPCOOH encourages the open reporting of infection incidents and risks as part of its adverse incident reporting procedure. This policy will cover all the aspects of infection control and decontamination that are required to protect all staff, patients and third parties, and those issues and procedures raised by Assurance framework or required for statutory purposes. The risk of transfer of infection to staff and patients through care activity is generally perceived as low, but there is little research to substantiate this, it is therefore possible that the risks are higher than currently recognised. There are however, activities undertaken where the risks to staff are greatly increased such as when disposing of used sharps.

2. Review of Policy

The Clinical Governance Lead will review the Policy & Procedures, with the Medical Director (Operations) and Clinical Executive, reporting any issues that require action to the Quality, Patient, Safety & Risk Committee on an annual basis.

3. Duties

Chief Executive

The Chief Executive has overall accountability for ensuring that EBPCOOH maintains adequate and appropriate controls and procedures to minimise the risks of infection to staff and patients. The Chief Executive will designate the prevention and control of healthcare associated infections (HCAI) as a core part of EBPCOOH Governance and patient safety programmes.

Clinical Executive and Medical Director

In accordance with Department of Health Guidance ‘Winning Ways’ (December 2003) the Clinical Executive and Medical Director have been designated as EBPCOOH’s Directors of Infection Prevention and Control (DIPC) and will:

Oversee control of infection policies and their implementation.

Be responsible for the Infection, Prevention Control and Decontamination within EBPCOOH.

Report directly to the Chief Executive and Council.

Have the authority to challenge inappropriate clinical hygiene practice.


Assess the impact of existing and new policies and plans and make recommendations for change.

Be an integral member of EBPCOOH’s Quality Governance Patient Safety and Risk Committee.

Chair the Clinical Review Group.

Produce an annual report on the state of healthcare associated infection in EBPCOOH and release this publicly.

Clinical Governance Lead

The Clinical Governance Lead has delegated responsibility for assisting the Clinical Executive and the Medical Director (Operation), in conjunction with all managers in developing, promoting, and monitoring improved infection control measures. The Clinical Governance Lead will monitor all reported incidents and risks and will ensure that where appropriate formal risk assessments are undertaken and recorded within EBPCOOH’s Risk Register.

All Managers

All Managers are responsible for implementing EBPCOOH’s Control of Infection Policies & Procedures, which includes:

Ensuring that a copy of the Control of Infection Policy is readily available to staff (an electronic version is available on EBPCOOH’s website).

Provide leadership and supervision to ensure control of infection procedures, including safe systems of work are fully adopted and applied to all staff.

Investigate, document and report all accidents, incidents and risks, in accordance with EBPCOOH procedures and recommend means of preventing reoccurrence.

Ensure good housekeeping standards are applied.

Operational/Departmental Managers will be responsible for overseeing the policy with regard to personal medical details and sickness absence.

Team Leaders

Have the responsibility to provide leadership and to promote responsible attitudes towards the control of infection. Through work based training, assessment and supervision they will be responsible for ensuring that all employees are competent in applying infection control procedures relevant to their job role, and are aware and adopt all safe systems of work. All accidents, incidents or risks must be reported immediately and fully documented using EBPCOOH reporting procedures.


All Employees In accordance with their statutory obligations under Health & Safety legislation all employees sub contractors must: -

Take reasonable care for the Health & Safety of themselves and any other persons who may be affected by their acts or omissions at work. This duty also includes taking positive steps to understand the hazards in the workplace, to comply with safety rules and procedures and to ensure that nothing they do or fail to do places others at risk.

Co-operate so far as is necessary, with his/her employer, to ensure that all relevant statutory regulations, policies, codes of practice and departmental procedures are adhered to.

Inform EBPCOOH, through EBPCOOH’s Risk/Accident Reporting Procedure of:

- Compliance with EBPCOOH’s Control of Infection Procedures.

- Any matter that the employee would reasonably consider represented a shortcoming in the employers’ protection arrangements for Health & Safety.

Particular regard must be paid to:

Wearing the appropriate protective clothing and safety equipment and the use of appropriate safety devices where applicable.

Complying with all safe-working procedures.

Reporting all faults, hazards, accidents, dangerous occurrences, regardless of whether persons are injured in accordance with EBPCOOH Policy.

Staff Illness and Reporting

It is important that staff remember that infection can be passed in either direction, i.e. patients to staff or staff to patients. Staff should inform their Line Manager, if they develop any of the following diseases, and should not report for duty unless advised to do so:

Skin infection or exposed areas of infestation

Severe respiratory infection (e.g. pneumonia, TB, not self limiting viral infections or the common cold)

Severe diarrhoea

Jaundice

Hepatitis

Infectious diseases, such as chicken pox, measles, mumps, rubella or scarlet fever

Any other infectious disease (E.g. HIV). Line Managers will be responsible for advising Human Resources and the Clinical Governance Lead of all illnesses reported in this way.

All such reporting will be treated in the strictest confidence. Clinical Governance Lead in conjunction with the HR Manager will liaise with Occupational Health if there is concern that a work acquired infection or other infection control issue is apparent.


Partnership working

In order to effectively manage risks associated with infection control it is essential that close working relationships are developed with other NHS Trusts and agencies to ensure a smooth transfer through the patients’ care pathway. Sharing of information regarding patients’ clinical conditions and the presence of any known infectious disease will assist in reducing the risk of cross infection and improve overall patient care. EBPCOOH reports any patient safety incidents through the National Reporting and Learning System to the National Patient Safety Agency (NPSA). EBPCOOH will involve patients and the public on its control of infection procedures through the Quality, Governance Patient Safety & Risk Committee and ensure that information such as organisational policy, handbook, annual report and minutes are available on EBPCOOH’s website.

4. Organisational Framework

4.1 Qualities Governance Patient Safety & Risk Committee

EBPCOOH Council has delegated responsibility to the Quality Governance Patient Safety and Risk Committee for developing and monitoring effective Policies, Procedures and best practices with regards to the control of infection as part of its overall risk management remit. This will be completed in association with the Clinical Review Group.

4.2 Clinical Review Group

This sub-group of the Quality Governance Patient Safety and Risk Committee are responsible for reviewing and recommending changes to Policy and practice. The purpose of the Group is to provide EBPCOOH with an objective and structured approach to implementing effective management of infection control and decontamination across all facilities and services provided by EBPCOOH. The primary aim is to provide a safe environment to all patients, visitors and staff.

4.3 Specialist Infection Control Advice

EBPCOOH will commission, under a Service Level Agreement, external specialist advice. This will be provided by an expert in Infection Control matters and may be a Nurse or Doctor with specialist training in this field.

4.4 Training and Education

All staff and sub contractors who work on or with EBPCOOH or potentially contaminable equipment will have effective induction and continuous education in control of infection and decontamination. This must include training in:

Basic microbiology and routes of transmissions

- “The chain of infection”

- Communicable diseases

Group 2 (previous Category III diseases) and their control

Relevant staff immunisations (what is required and where to get them)

Universal precautions.


Management of sharps and sharps injuries

General hygiene and the storage and preparation of food

All staff must understand their responsibilities under this policy before commencement of duties. This training is delivered through the e-Core Learning programme and is mandatory for all staff. Operational performance with regard to the use of universal precautions is the responsibility of each individual member of staff. Departmental Managers and Team Leaders will be responsible for assessing “Operational” compliance with this policy whenever they carry out operational assessments of staff. They should ensure that these matters are referred to when writing their assessment reports. The Head of Education will ensure that control of infection is included in all Induction and relevant continuing education programmes. In particular all staff as appropriate should be made aware of the risks from blood and body fluids, including the appropriate consideration of gloves and management of sharps as part of their induction and basic training.

4.5 Occupational Health

EBPCOOH provides an Occupational Health (OH) Service to all employees through Royal Berkshire Hospital Occupational Health Service. This service is available during normal working hours to provide advice and counselling in relation to infection control incidents, outside of normal hour’s advice should be sought from the appropriate Departmental Manager and On Call Manager. Staff may obtain contact details for the Occupational Health Service from the Human Resources Department and on the needle stick injuries posters displayed t all the PCC/UCC sites. The Occupational Health Service will provide a pre-employment health assessment as appropriate, which should include:

Completion of a confidential health questionnaire

Occupational history with details of previous exposure to infection risk

Skin examination to evaluate risk from chronic skin disease

Previous occupational health problems

Vaccination and immunisation history:

- Check for evidence of BCG or undertake Heaf test

- Check immunity to rubella

- Provide polio booster if more than ten years since last booster

- Document last date of tetanus booster

- Give advice and vaccination with regard Hepatitis B vaccination as required.

4.6 Immunisation Guidance

EBPCOOH clinical staff should be vaccinated as appropriate against the following:


Tetanus

Hepatitis B

Rubella

Poliomyelitis

Diphtheria

Tuberculosis (BCG)

Measles, Mumps and Rubella (MMR)

The majority of staff should have had lifelong immunity conferred by their normal childhood vaccination programmes. These include diphtheria, tetanus, and BCG. If there is any doubt then staff should discuss their vaccination status with Occupational Health or their GP. Advice on the need for immunisation including booster doses is available from GPs or through the Occupation Health Service provided through EBPCOOH.

4.7 Staff Who Cannot Gain Immunity

If you have to deal with a patient who has a known disease from which you know you are not immune:

Inform dispatch control and ask if anybody else is available to carry out this detail.

Avoid close contact with patient.

Inform Occupational Health via dispatch control as soon as possible afterwards.

Complete adverse incident report form record and submit to your line manager

4.8 Hepatitis B Vaccination

EBPCOOH is aware of the potential risk to staff caused by the exposure to Hepatitis B and recognises its responsibility to staff to ensure that adequate immunisation is available. It is also vital that patients are protected, e.g., from transmission of the virus from a member of staff who is a carrier. The source of Hepatitis B is blood and other body fluids. It is transmitted through direct contact. Some patients, who have had Hepatitis B, can develop a “Carrier Status” whereby they carry the virus and can transmit it long after they have recovered from their own episode of Hepatitis. Although carriers of Hepatitis B seem healthy they can remain infectious for many years. Contamination can occur by any of the following methods:

Injected (for instance by needle stick injury).

Conjunctiva contamination.

Allowed to contaminate a recent (less than 24 hours old) cut or abrasion.

Vaccination is the most effective and safest method of protection. Hepatitis B vaccination is available for all staff who work in contact with patients or who may become exposed to blood or body fluids. This includes:

Non Clinical Staff working in Patient facing areas.

All EBPCOOH employed clinical staff.


Any staff or sub contractors used by EBPCOOH in a patient care capacity

The Hepatitis B vaccine is administered on three occasions. Following the initial inoculation, further vaccine is administered at 4 weeks and six months intervals, followed by a blood test to check that the Hepatitis B antibodies are present. EBPCOOH’s Occupational Health Provider will maintain a database of all staff vaccinations. Occupational Health will notify staff of due vaccination dates. It must be stressed that it is every employee's responsibility to ensure that they receive their inoculations by the due date. This is particularly important in the case of the Hepatitis B vaccination programme.

5. Audit and Inspection

All The EBPCOOH work locations and premises will be subject to an annual audit and inspection of infection control and decontamination procedures that will normally be carried out at the same time as Health & Safety workplace inspections of EBPCOOH’s premises. The audit and inspections will be carried out by the Operational/Departmental Manager, and the local Safety Representative.

The Audit and Inspection team will look into matters including:

Number and nature of sharps injuries

The storage and disposal of clinical waste and sharps

The storage of used linens

The decontamination and cleanliness of EBPCOOH vehicles and equipment

The decontamination and cleanliness of medical equipment

Documentation, adverse events reports and accident books

Exception reporting

The Human Resources department will make available to the infection prevention, Control & Decontamination inspection team an anonymised list of work related infections, acquired by staff at any locality that is to be visited for inspection purposes. It will be the responsibility of the Operations Manager to acquire this list from the Human Resources Department, which will be extracted from records held in HR. Infection control issues identified during inspections will also be separately reported to the Quality, Governance, Patient, Safety & Risk Committee. Operational/Departmental Managers will carry out ad hoc inspections of PCC’s/UCC and vehicles, on a quarterly basis, to ensure that the principles of this policy are being followed. The result of these inspections will be routinely reported to Quality Governance Patient Safety and Risk Committee if any discrepancies are noted and reported as risks in accordance with EBPCOOH’s Risk Management Policy.

6. Monitoring Key Performance Indicators will be monitored by the Clinical Executive every six months, these will include:


Responsibilities of staff will be monitored through attendance at meetings, management of systems, development of reports and the appraisal process.

Number and percentage of staff completing mandatory and induction training in year.

Number of incidents reported through the Risk Management Process

Number of incidents and complaints reported from members of public and external agencies/healthcare providers.

Monitoring of vehicle cleaning

Number of inoculation incidents reported and a review of the EBPCOOH’s management, support of staff, reporting arrangements and training.

All of the KPI’s are monitored at the Clinical Review Group. Specific ones are also monitored at the following;

Clinical Review Group will monitor progress and outcomes of Clinical investigations, patient involvement and subsequent action plans, and report to the Quality Governance Patient Safety and Risk Committee.

The Quality Governance Patient Safety and Risk Committee monitor all of the above and in particular EBPCOOH Monitoring of Action Plans which includes high level investigations.

7. Infection Control Training

Induction Training

Infection control and prevention training will be provided to all staff grades within EBPCOOH

as part of the induction training programme. The level of training will be dependent on their

role EBPCOOH.

Induction training will only include Hand Hygiene and Basic Infection Control Procedures as in Table 1 to the required roles. All other training will be covered within clinical training and E-Learning.

8. Background Information

8.1 Basic Microbiology - Micro-organisms and their Properties

The term micro-organism, or microbe, is used to describe any organism, which is too small to be seen with the naked eye. Many micro-organisms live independently of man and those that are dependent exist in a host-organism relationship that is generally harmless and may even be mutually beneficial. Of the vast array of organisms, only about 50 or so species do, in fact, cause harm to humans. Micro-organisms capable of causing disease are referred to as Pathogens. Infection is a pathological process, which involves the damaging of body tissues by pathogens, or by the toxic substances produced by these pathogens. They generally thrive and multiply in darkness, warmth and moisture, and infection is usually accompanied by signs and symptoms in the patient, E.g. pain, swelling and/or fever. Pathogenic micro-organisms may be classified as follows:

Bacteria - are minute organisms about one-thousandth to five-thousandths of a millimetre across. They are susceptible to a greater or lesser extent to antibiotics.


Viruses - are much smaller than bacteria and although they may survive outside the body for a time, they can only grow inside body cells. Viruses are not susceptible to antibiotics, but there are a few anti-viral drugs available which are active against a limited number of viruses.

Pathogenic fungi - can be either moulds or yeasts. An example of a mould that causes infection in humans is ringworm, which can also infect nails. A common yeast infection is thrush, caused by an organism Candida albicans. Immunosupressed individuals may develop systemic infections affecting the whole body; one example is aspergillus, which is usually an opportunistic organism taking advantage of the persons lowered immune response.

Protozoa - are microscopic organisms, but are larger than bacteria. Those that cause disease in humans include Cryptosporidium parvum, which causes diarrhoeal illness, and the malaria parasite.

Worms - are not always microscopic in size, but pathogenic worms do cause infection and some can spread from person to person. Examples include threadworm and tapeworm.

Prions - are thought to be found in the central nervous system and also in other tissues such as the lymph glands particularly the tonsils. Intensive research into prions continues: they are thought to be the cause of transmissible spongiform encephalopathies (TSE). During the 1980’s new types of prion evolved in the UK, including bovine spongiform encephalopathy (BSE) in cattle and variant Creutzfeldt-Jakob disease (vCJD) in humans.

8.2 The Transmission of Infection

The Chain of Infection - Transmission of infection occurs when the infectious agent leaves its reservoir or host through a portal of exit and is conveyed by some mode of transmission and enters through an appropriate portal of entry to infect a susceptible host. This is the chain of infection. For any given infection, understanding the chain of infection allows appropriate control measures to be recommended. The Reservoir of Infection - The reservoir of an infectious agent is any person, animal, arthropod, plant, soil or substance (or combination of these) in which the infectious agent normally lives and multiplies. It is dependent on the reservoir for survival and it produces itself there in such a way that it can be transmitted to a susceptible host. The Portal of Exit - The portal of exit is the path by which an agent leaves the source host, which usually corresponds with the site at which the agent is localized, for example, respiratory tract, genito-urinary system, gastrointestinal system, skin or blood.


The Portal of Entry - The portal of entry is the route by which an agent enters a susceptible host. This provides access to tissues in which the agent can multiply or a toxin can act. The main portals of entry are:

The respiratory Tract - Through inhalation of organism (e.g. tuberculosis, diptheria and mumps)

The Alimentary Canal - Through ingestion of contaminated food or water (e.g. salmonellosis and dysentery)

The Skin and Mucosa - Either by the passage of organisms through damaged skin, (infected wounds), or by the inoculation of organisms. (E.g. Hepatitis B transferred from contaminated needles)

The Placenta - Via transfer of organisms from the maternal circulation to the foetal circulation (E.g. rubella, cytomegalovirus and syphilis)

Sources of infection are:

Infected patients,

Colonised patients (who may show no signs of infection),

People incubating an infectious disease,

Healthy carriers.

Infection is spread:

By contact (e.g. with contaminated hands, instruments, fomites (objects), food and water.)

Or through the air via respiratory droplets, dust or skin scales carrying micro-organisms.

Infection can be acquired by:

Inhalation

Ingestion

Percutaneous inoculation e.g. via wounds or injections

Sexual contact

The risk of transmitting infection to patients or staff can be minimised by adopting simple infection control measures including:

8.3 General Infection Control Considerations

Many patients have an unknown medical history. It is therefore important that personal contact with patients be compatible with the Health & Safety of patients and staff. In case of a known or a suspected infectious disease staff will, where possible, be forewarned and they must don appropriate protective clothing provided. In case of an unknown diagnosis EBPCOOH personnel must take appropriate precautionary measures as indicated by the patient’s symptoms or clinical presentation these are known as ‘Universal Precautions’.


Traditionally, Health provider Services have classified infectious diseases into one of three categories, and operated protocols that have been category specific. However, in adopting the comprehensive use of Universal Precautions, the need to retain the special measures of Categories 1 and 2 has now been negated. Specialists have advised that the routine use of Universal Precautions is totally appropriate to the successful management of patients that previously fell within these two categories. Therefore, the old working practices associated with Categories 1 and 2 have been withdrawn, leaving only those patients with illnesses in Category 3 as requiring measures. In considering infection control and decontamination issues it is important that all personnel maintain a sense of proportion when considering personal risks.

Adherence to infection control practices at all times:

Attention to simple hygiene.

Observance of health care programs including immunisation,

Use of appropriate protective clothing whenever necessary,

Regular cleaning and decontamination of vehicles and equipment,

Keeping a stock of materials and facilities for dealing with clinical/infectious waste readily available,

The safe disposal of sharp instruments and clinical infectious waste in line with the EBPCOOH policies.

Efficient laundry arrangements.

Control of infection is dependent upon the correct and conscientious application of all procedures. The basic methods of protecting personnel from contracting an infection/infectious disease from a patient and for preventing cross infection between patients are:

8.4 Simple Hygiene

High standards of personal hygiene must be maintained at all times. All staff should bathe/shower daily and change their clothing frequently.

8.5 Hand washing / Hand cleansing

Hand washing is the single most important factor in preventing cross infection. This procedure must include thorough washing of all surfaces of the hands, using soap and warm running water, rinsing carefully and thoroughly drying them, preferably on disposable paper towels.

8.6 Hand Washing Technique

Technique is more important than the solution used. Effective hand washing technique involves 3 stages: preparation, washing and rinsing, and drying.

Remove jewellery (wedding rings may be kept on if necessary).


Preparation requires wetting hands with water and then applying liquid soap / solutions.

This should be followed by vigorous rubbing of hands for 10-15 seconds paying particular attention to tips of fingers, thumbs and between the fingers.

When hands are washed in a hasty manner certain areas tend to be missed. The diagram shows the areas of skin that are commonly missed during poor hand washing. Hands should be thoroughly rinsed and properly dried using paper towels. There are two populations of micro-organisms found on the skin. The resident bacteria live in the deeper skin layers; they are not readily transferred and are usually not harmful. Transient micro organisms do not normally live on the skin but are both readily acquired and transferred by touch. In clinical settings hands can cause cross infection by transferring these transient micro-organisms between patients but are easily removed by simple hand decontamination procedures. The wearing of gloves is not an alternative to hand hygiene.


(NPSA, 2009)

Hands should be washed:-

Before After

Taking a break / going home

Undertaking a care procedure

Putting on protective clothing

Eating, drinking, handling food

Smoking

Going to the toilet, blowing nose or covering a sneeze Direct contact with a patient Handling contaminated items such as dressings, bedpans etc Cleaning equipment / environment Handling dirty linen or waste Hands become visibly soiled Cleaning up spills Removal of gloves Smoking

8.7 Hand Washing Facilities

Hand washing facilities are available in all toilets and washroom areas of EBPCOOH premises. These should not have a plug and should be fitted with liquid soap dispensers. Nailbrushes should be avoided unless they are single use/disposable. Disposable paper towels/Hand dryers should be available for drying.


Most clinical areas have hand washing facilities available and these should be utilised whenever necessary. Hand washbasins are not available on EBPCOOH vehicles. When staff are unable to access hand washing facilities it may be necessary to use other methods to decontaminate the hands. Hand wipes and/or alcohol gel rubs can be used just as effectively.

8.8 Use of Alcohol Gel

Alcohol gel will not penetrate through soiling such as blood or dirt – hands should be cleaned as much as possible with a hand wipe before gel is applied, unless hands are not soiled, when gel can be used alone. When using a gel, apply 3-5ml to visibly clean hands and rub using the hand washing technique, until the alcohol has evaporated and hands are dry. Only 3-4 applications of alcohol gel should be used before hands will need to be washed as they may become ‘tacky. Hand Gel Dispensers must be available at every patient contact area. Hand Gel Dispensers should not be placed next to sinks within EBPCOOH premises, as hand washing should be the primary hand cleaning method. When empty the personal issue hand gel should be replaced and not refilled from existing bottles, due to the risk of infection contamination.

9. Protective Clothing Ensure that the following items of protective clothing are available and that you know when to use them:

Gloves - Disposable latex/nitrile gloves (assorted sizes)

Rubber household gloves (assorted sizes)

Disposable Protective Clothing, e.g. plastic aprons.

9.1 Gloves

The nitrile medical gloves provided should be worn:

When handling blood/body secretions from any patient, or when dealing with contaminated equipment in the PCC, UCC or on a vehicle or home visit.

Nitrile gloves should not be donned until at the patients’ side.

Nitrile gloves must be changed if contaminated with blood/body fluids.

Nitrile gloves must never be worn whilst driving a vehicle either to or from a home visit.

Caution: Use of Hand Gel may cause irritation to hands if not used correctly


Used disposable gloves must be put into a yellow plastic clinical waste bag for incineration. Rubber household gloves should be worn for any cleansing procedure. After use they should be washed with detergent and water and dried. Hands must always be cleansed thoroughly after removing gloves as their use can only reduce the amount of hand contamination rather than prevent it altogether.

9.2 Disposable Protective Clothing

Disposable plastic aprons should be worn:

For any cleaning procedure.

When there is any possibility of contaminating your clothes.

When handling any patient who is bleeding or incontinent.

When dealing with any patient with a suspected infection/infectious disease.

A fresh apron should be used for each patient. Dispose of used aprons into a yellow plastic clinical waste bag for incineration.

Coveralls are not required routinely. They should only be worn:

When dealing with infections caused by the more hazardous organisms.

Upon instruction from a Medical Practitioner.

9.3 Face Masks

Use of facemasks is recommended during procedures when there is likely to be a splash of body fluid into the mouth, or if the patient is prone to episodes of coughing or sneezing, or during intubation of patients who are suspected to have meningococcal disease, or suspected TB.

9.4 What to Wear When

No Exposure to blood/body fluids anticipated

NO PROTECTIVE CLOTHING REQUIRED

Exposure to blood/bodily fluids anticipated, but low risk of

splashing

WEAR GLOVES & PLASTIC APRON

Exposure to blood/bodily fluids anticipated, high risk of splashing

WEAR GLOVES, PLASTIC APRON & FACE MASK


9.5 Replenishment of Stocks

After use, replenish the stock of protective clothing kept in an EBPCOOH location via the medications management team as soon as possible.

10. Cleaning and Decontamination

10.1 Care of Vehicles

The maintenance of high cleanliness standards on all surfaces and equipment is a crucial factor in the prevention and control of infection. All staff have an individual responsibility to keep the vehicles & equipment clean and thus to reduce the risk of cross infection to themselves, their colleagues and their patients. Whilst all dust, dirt and moisture can harbour infection, the key risks are associated with contamination arising from contact with blood and body fluids, mucous membranes or damaged skin. In all cases the surface or equipment must be thoroughly cleaned and in addition must also be disinfected in order to destroy any pathogenic microorganisms.

10.2 Cleaning System 1

Cleaning is a process that physically removes contamination but does not necessarily destroy microorganisms. Detergent - is used as the primary cleaning agent It acts as a cleaning agent that also maximises the effectiveness of the disinfection process. It should be made up into a solution with hot water according to manufacturers’ directions. Staff should wear appropriate PPE (gloves as a minimum). Surfaces should be vigorously cleaned using the solution; the cloth must be single use and disposed of following cleaning to prevent further contamination. Care should be taken when using near or around electrical items when the cloth should be moist, not dripping. Face masks should be used for all occasions where there is any likelihood of a splash coming into contact with the face. After leaving for approximately 30 seconds wipe clean with tissue roll, which should be discarded as Clinical Waste (Cat B) if the situation does not allow for a solution of detergent and hot water to be made up an alcohol or detergent wipe can be used as an alternative. Alcohol wipes must not be used to clean electrical equipment.


10.3 Cleaning System 2

Disinfectant - used as the secondary cleaning agent. Disinfectant must always follow the application of the detergent cleaner, ensuring that the bulk of the contamination has firstly been removed and the site made ‘visibly clean’ in order that maximum effect is derived from the application of the disinfectant. The disinfectant should be made up according to instructions and applied in a similar manner to the detergent. However it is important to leave in situ for 3 minutes in order for decontamination to take place. Disinfectant should be rinsed off and wiped dry with tissue roll. Tissue roll and gloves etc. should now be regarded as ‘Clinical Waste’. Disinfectant should not be applied to surfaces where Acid is present as it can form Ammonia (e.g. Urine; which should be managed using System 1 prior to the application of System 2 on every occasion).

10.4 Cleaning Materials Options Chart

CHEMICAL

ADVANTAGES

DISADVANTAGES

USES

Chlorine based Hypochlorite (E.g. Domestos, Milton) Diluted to 10,000 parts per million. For blood spills/100,000 parts per million

Wide range of bacterial, virucidal, sporicidal and fungicidal activity.

Rapid action

Non-toxic in low concentrations

Can be used in food preparation areas

Cheap

·

Inactivated by organic matter

Corrosive to metals

Diluted solutions can be unstable

Need to be freshly prepared

Does not penetrate organic matter

Bleaches fabrics

· Need ventilation

Can be used on surfaces and for body fluid spills. Under no circumstances with urine as this will produce ammonia gas.

Sodium Dichloroisocyanurates NaDCC) E.g. Precept, HazTab, Sanichlor

Slightly more resistant to inactivation by organic matter

Slightly less corrosive

· More convenient, long shelf-life and easy to make up

As above

Can be used on surfaces and for body fluid spills.


Alcohol 70% E.g. ethanol

Good bactericidal, fungicidal and virucidal activity

Rapid action

Leaves surfaces dry

· Non-corrosive

Non-sporicidal

Flammable

Does not penetrate organic matter

· Requires evaporation time

Can be used on surfaces or for skin/hand decontamination

Chlorhexidine E.g. hibiscrub, Chlorhexidine wound cleaning sachets

Most useful as disinfectants for skin

Good fungicidal activity

· Low toxicity and irritancy

Limited against viruses

No activity against bacterial spores

· Inactivated by organic matter

For skin / hand decontamination

10.5 Equipment Cleaning Guide

Detergent clean = 1 Disinfectant Clean = 2

Item Description Information Cleaning

1 Peak Flow Meter Remove disposable mouthpiece Mouthpiece – Single Patient Use Main Body – 1 & 2

2 Stethoscope

Remove Diaphragm/bell unit from tubing. Unscrew bezel to diaphragm. Unscrew earpieces from headset.

Diaphragm / Bell – 1& 2 (Do not immerse) Diaphragm – 1 & 2 Headset – 1 & 2 Tubing – 1 & 2 (Do not immerse) Ear Pieces – 1 & 2

3 Sphygmomanometer Inflatable Cuff – 1 & 2

Pressure Gauge – 1 & 2 Carry Case – 1 & 2

4 BM Kit Remove from case

Body – 1 & 2 (Do not immerse) Case – 1 & 2 Blood letting pen – 1 & 2 Lancets – Single Patient Use (Discard as per sharps procedure)

5 Thermometer

Do not immerse unit in water or any other solution, or allow liquid to penetrate the outer casing.

1 & 2

6 Mobile Phone 1 & 2

7 Nebuliser 1 & 2

8 Defibrillator 1 & 2

9 Oxygen Flow Meters Remove from vehicle. 1 & 2 – Ensure dry and clean of any detergent prior to use.

10 Uniform (UCC) Spare should be kept on Station Machine wash @ 40°c or hotter if heavily soiled – if severely soiled dispose and replace.


10.6 Daily Clean

Floors should be cleaned with a fresh hot water and soap/detergent solution. If the mop becomes contaminated with body fluids, it should be changed immediately. Otherwise, mops should be changed every other week. Re-usable mop heads should be laundered weekly. Furniture and equipment should be washed as above using a disposable cloth and dried thoroughly with a disposable paper towel. Where a premises/vehicle has become contaminated with blood or body fluid, cleaning must take place following the discharge of the patient. Disposable cloths and paper towels should be used for management of blood and body fluid spillages. Clinical waste bags should be placed in a clinical waste bin. Where this is not possible they should be disposed of at the earliest opportunity. At the end of a shift clinical waste bags should not be left on a vehicle, they should be removed, tied and put in the appropriate place for collection. Sharps boxes may be left onsite or on a vehicle but should be in the closed position. The interior of the GP visit vehicle should be checked for sharps and other discarded clinical waste and removed at the end of each shift. Daily cleaning at EBPCOOH premises is carried out by external cleaning companies. All work areas need to be cleaned by appropriate staff (clinical or reception/admin) and recorded on the appropriate cleaning schedules (Appendix 7).

10.7 GP Visit Vehicle Interior Cleaning – Regular Clean

All vehicle interiors should be subjected to a comprehensive clean on a weekly basis. It is accepted that operational demands are likely to restrict opportunities for the weekly clean to be undertaken at a designated time. Ensure that appropriate items of PPE are worn and the vehicle is well ventilated. All walls, ceiling and the inside of cupboards can then be cleaned. Usually a general detergent clean using disposable towels or cloths will suffice, however any areas visibly contaminated with blood or body fluids should be cleaned with the appropriate disinfecting agent.

10.8 Linen

EBPCOOH requires that any examination couch covers should be single patient use only and be disposed of in the usual clinical waste procedures. Any blankets should be considered single use as there are no laundry facilities on our premises. To reduce the risk of cross-contamination mops and disposable cloths should not be used or transferred between different areas. Cleaning equipment must be stored clean and dry between uses. Do not store brushes or mops in disinfectant solution.


10.9 Single use Equipment Equipment that should be discarded or decontaminated after each use must be checked daily and stocks replenished where necessary. Non-sterile equipment such as, oxygen face masks, airways, suction equipment, rebreathing bags, Entonox connecting tubing, oxygen tubing, electrodes, laryngoscope blades, vomit bowls, urinals and bed pans are disposable and are for single use only. All such equipment can be used once and disposed of in a yellow plastic clinical waste bag, seal and send for incineration. All sharps equipment must be put into a designated sharps container and disposed of as per EBPCOOH policy.

10.10 Sterile Equipment

Sterile equipment is required for carrying out invasive procedures e.g. intravenous cannulation and infusions, intubation, dressings and suction catheters. Before using sterilised items always check that the “use by” date has not expired and inspect the packaging, if it is not clean, dry and intact, the equipment may not be sterile and must not be used.

10.11 Care of Equipment

All equipment must be handled and used in accordance with manufacturer guidelines and following training instruction procedures.

10.12 Reusable Equipment

Decontamination methods must conform to local policies. In most instances equipment can be decontaminated by thorough cleaning in detergent and hot water. Because many microorganisms thrive in a moist or wet environment, the most important part of the cleaning process is thorough drying.

10.13 Repairs/Servicing

Equipment requiring repair or servicing must be cleaned of all organic material, by the professional user or other appropriately trained staff, before it is sent away. All reusable medical devices must be decontaminated in accordance with manufacturer’s instructions as well as legislative and best practice requirements. It is also important to ensure that vehicles going for maintenance or repair are sent to external contractors, in a state which is safe for non clinical staff to work in.


All clinical waste should be removed and the sharps box should either be removed or placed in the closed position. The interior and equipment should be checked for sharps and contamination, and cleaned if necessary. If cleaning and checking of the location has not been possible external contractors should be notified of the risk and advised of any precautions to take.

11. Decontamination Procedures

11.1 Spillage Management

Effective management of blood and body fluid spillage is a crucial factor in controlling the spread of infection. Exposure to any such fluid constitutes a risk to all staff and others within the immediate environment. These risks can be minimised by dealing promptly with the spillage by appropriate cleaning and disinfection. In general, the volumes of most blood or body fluid spills that occur are not excessive, e.g. blood smeared on a sharps box. They can be managed by wiping with a detergent wipe. In the event of a larger spill where this method would not be sufficient, the use of absorbent powder from a spillage kit should be used.

11.2 Spillage Kit

The spillage kit should always be kept in a designated, easily accessible place. It should comprise:

Non-sterile gloves

Disposable plastic apron

Disposable paper towels

Clinical waste bag

Small container of general purpose detergent

Hypochlorite solution (E.g. household bleach or Milton) or sodium Dichloroisocyanurates compound granules (E.g. Precept, Sanichlor)

Scoop & scraper to deal with broken glass/sharps

The kit should be replenished after each use.

11.3 Immediate Action Do not pick up any broken glass, even with gloved hands. Use a scoop & scraper, or two pieces of rigid card if such equipment is not available, and place broken glass into the sharps container. Absorbent granules from the spillage kit should be applied by being liberally sprinkled directly onto the spill where it will congeal the fluid. Once the fluid has been stabilised cover it with a paper towel until it is convenient for the spillage to be safely dealt with. For spillage of low-risk body fluids non-blood containing excreta, vomit, urine etc, use the following guidelines:


11.4 For low risk fluids: Detergent and Water

Keep area sectioned off until spillage has been safely dealt with

Wear protective clothing

Mop up organic matter with paper towels or disposable cloths and dispose as clinical waste

Clean surface thoroughly using a solution of detergent and hot water with paper towels or disposable cloths

Rinse the surface and dry thoroughly

Dispose of materials as clinical waste

Clean the bucket / bowl in fresh hot soapy water and dry

Discard protective clothing as clinical waste

Wash hands

For spillages of high-risk body fluids such as blood, the following guidelines should be followed:

11.5 For higher risk fluids: Disinfection

Section off the area containing the spillage until it has been safely dealt with

Ventilate area if possible


Soak up excess fluid using disposable paper towels

Cover area with hypochlorite solution (E.g. Milton – diluted to 10,000 parts per

million for blood spills / 100,000 parts per million for equipment) or/ NaDCC (e.g. Precept or Sanichlor)

NB Chlorine based disinfectants must not be used to treat urine spills!

Remove organic matter using the towels and discard as clinical waste

Clean area with detergent and hot water and dry thoroughly (micro-organisms cannot multiply on dry surfaces)

Clean the bucket / bowl in fresh soapy water and dry

Discard protective clothing as clinical waste

Wash hands

11.6 Disinfection of premises where patient has been accepted

Following discharge of any known or suspected “infectious” patient:


Open the windows if possible

Discard any disposable clothing, equipment or clinical waste into a yellow plastic clinical waste bag, seal and send for incineration as soon as possible.

If it has been used, dispose of the sharps container as per EBPCOOH policy.

Remove any portable non-disposable equipment, which has been used, and decontaminate.

Wash the floor and wipe all surfaces with detergent and water.


Wipe over horizontal surfaces with chlorine releasing solution 1000 p.p.m. e.g.Sodium Dichloroisocyanurates (NADCC).

PLEASE NOTE:

Chlorine based solutions; powder or granules may damage some fabrics and metals.

Must only be used in well ventilated areas.

Must be used at the correct strength i.e. 10,000 p.p.m available chlorine for dealing with spillages of blood and body fluid; 1000 p.p.m available chlorine for disinfecting surfaces which are not visibly contaminated.

Must not be used on spillages of urine, blood or body fluids in confined spaces.

11.7 Disposal of used Sharps Containers and Clinical Waste All Sharps bins that are ¾ full are to be sealed and placed at the secure central clinical waste collection point to be collected weekly by the specialist waste management contractors. All clinical waste yellow bags are to be sealed on a daily basis and placed at the central clinical waste collection point to be collected weekly by the specialist waste management contractors.

11.8 Care of the Deceased

In the event of infectious patient dying in an EBPCOOH patient care facility, infection control precautions must be continued until they are taken from the area. Morticians/Ambulance/Hospital staff must be advised of any infection risk.

12. Risk Assessment of Medical Devices and other Equipment

12.1 New Equipment

All new equipment will be risk assessed; by members of the Medicines Management Team in particular they must specifically consider the Infection Control and Decontamination (ICD) issues that arise with each item.

Where reasonably practicable all medical devices/equipment must be single use only. In the event that an affordable single use item is not available then a re-usable device will be considered for purchase. The Medical Director must be advised of the potential purchase of any equipment that carries a ICD risk so that they can ascertain whether the risk should be accepted or not.

12.2 Existing Equipment

The Clinical Governance Lead must carry out a review of all types of non-disposable equipment used in EBPCOOH on an annual basis and investigate purchase of any single use items that could replace existing contaminable equipment and report this through the Quality, Governance Patient Safety & Risk Committee. Where possible a planned programme should be put in place to replace equipment with versions that are easier to clean.


12.3 Risk Assessment for Decontamination of Equipment

RISK APPLICATION OF ITEM MINIMUM

STANDARD

Low In contact with normal and intact skin (e.g. stethoscopes, BP cuffs) Clean & dry

Intermediate

In contact with intact mucous membranes, or contaminated with

virulent or readily transmissible organisms (body fluids), or prior to

use on immuno-compromised or highly susceptible patients e.g. with

burns

(e.g. Thermometers, respiratory equipment etc.)

Disinfect or single-use

High In contact with a break in the skin or mucous membrane, or for introduction into body areas

Sterilise or single-use


Appendix 1 Accountability Line Diagram


Appendix 2 Management of body fluid spillages

(Adapted from the Revised Cleaning Manual, NPSA (2009)


Appendix 3 Management of Human Bites


Appendix 4 Inoculation Incidents Policy & Procedures

Introduction

Employers have a general duty under Section 2(1) of the Health and Safety at Work Act 1974 (HSW Act) to ensure so far as is reasonably practicable, the health, safety and welfare at work of all of their employees. Section 2(2) of the HSW Act gives a detailed list of things to which the employer must, so far as is reasonably practicable, pay particular attention. Those relating to this policy and procedures are as follows:

Making arrangements for ensuring safety and absence of risks to health in connection with the use, handling, storage and transport of articles and substances

The provision of such information, instruction, training and supervision as is necessary to ensure the health and safety at work of the employees.

The provision and maintenance of a working environment for employees that is safe, without risks to health and adequate as regards facilities and arrangements for their welfare at work.

Employees also have a duty under Section 7 of the HSW Act, to take reasonable care for their own health and safety and that of others who may be affected by their acts or omissions at work. Therefore, employees should use correctly all work items provided by their employer, in accordance with the training provided and the instructions they receive to enable them to use items safely. Employee’s duties under Section 7 of the HSW Act also include co-operating with their employer to enable the employer to comply with statutory duties for health and safety. The Management of Health and Safety at work Regulations (1999) require the employer to assess any risk arising from a work activity, taking remedial action as appropriate and to have suitable arrangements for safeguarding the health and safety of employees and others. General Policy Statement All reasonable steps will be taken by the EBPCOOH to provide a safe and healthy working environment with safe systems of work for its employees. This policy, which applies to all employees who come into contact with sharps in the course of their work, aims to;

Prevent needle stick injuries through procedures that must be adhered to, for the safe preparation, use, handling and disposal of all sharps.

Provide procedures to be followed in the event of a sharps injury to an employee.

Careless acts, where sharps have not been correctly and safely disposed of, thereby causing a hazard with risk of infection to themselves or others will not be tolerated.


Where investigation shows that an employee has been negligent in his or her responsibility to carry out the correct procedures for the safe disposal of sharps, disciplinary action will be taken against that employee.

Procedure for the safe preparation, use, handling and disposal of sharps.

All Operational Managers and staff must be aware of and adhere to EBPCOOH’s procedures for the safe preparation, use, handling and disposal of sharps, which are as follows;

All sharps containers in use must comply with BS 7320 and must be assembled carefully, following the manufacturer’s instructions

It is the responsibility of the user to dispose of the sharp correctly and safely. Do not pass a sharp to anyone else to dispose of.

Sharps containers must be located conveniently in EBPCOOH premises.

Whenever possible the sharps container should be taken to the task, as used sharps must not be carried about unnecessarily.

In preparation for carrying out a procedure with a sharp, ensure that a suitable sharps container is available at a position convenient to the person who is about to use the sharp.

Never re-sheath a needle or cannula.

If a needle is attached to a syringe, dispose of as one, do not attempt to separate the two.

Place sharps directly into the sharps container immediately after use.

Never put fingers inside a sharps container

Sharps containers must never be overfilled and should be securely closed and locked when:

- Debris reaches the one inch below the warning “DO NOT FILL ABOVE THE LINE” mark (Never fill above three-quarter full, but in the case of containers carried on vehicles, never fill above half level).

- Used after invasive treatment on a known or suspected infectious patient

- Damaged or leaking.

Never perform invasive treatment in a moving vehicle.

Glass phials must be opened using the correct tool provided so as to prevent injury and then disposed of as a sharp.

Sharps containers must be disposed of correctly in line with local procedures.

Staff need to pay particular attention for their safety when working on a task which involves, or has involved prior to their arrival on scene, people from other medical authorities, who are using or could have used sharps and do not take the correct and safe action to dispose of their sharps.


Information and Training

EBPCOOH will provide sufficient information, instruction and training as is necessary to ensure that all employees who come into contact with sharps in the course of their work have the knowledge required to:

Understand and comply with EBPCOOH’s policy and procedures for the safe preparation, use, handling and disposal of sharps.

Understand the risks associated with needle stick injuries and the follow-up procedures required should such an injury occur.

Understand the requirements for compliance with health and safety legislation.

Assist in reducing needle stick injuries within the EBPCOOH.

Guidance for Management and Staff on Procedures for Accidental Inoculation

with a used needle or other sharp instrument.

In the event of an accidental inoculation with a used needle or other sharp instrument, the Operational Manager/On Call Manager must be informed immediately. The Operational Manager/On Call Manager is to ensure that the following actions are carried out as soon as possible:

Establish that the wound has been thoroughly washed with large amounts of clean water, made to bleed and then a plaster applied – immediately following the incident. If water is not available the wound should be cleaned with alcohol (gel or wipe).

Wherever possible, identify the source and name of the patient involved and obtain a good history of the incident.

Instruct the injured member of staff to report to an Accident & Emergency Department or Occupational Health Provider as soon as possible for assessment and treatment.

Treatment depends on the incident and assessment as follows:

- Assess if had Hep. B vaccines

- Assess Hep. B antibodies

- Blood to be taken for –

- Hep B antibodies

- Storing (for 3 months later)

Treatment could be:

Emergency Hep. B course

Hep. B Boosters – required 3 – 5 years

Immunoglobulin

Tetanus – 10 yearly

Counselling – leave door open.

If patient/client involved:

Blood to be taken for Hep. B antigens

Storing(depends on history and doctor)


Should the member of staff have any uncertainty about infection risk, they should contact the relevant Occupational Health Provider for advice. If the Occupational Health Provider is closed or unavailable they should seek advice from the nearest Accident & Emergency Department. The Operational Manager/On Call Manager is to inform the relevant Occupational Health Provider, Departmental Manager & HR Manager of the incident at the earliest opportunity and ensure that any follow up action required for the injured member of staff is carried out. In accordance with EBPCOOH’s Policy on Accident/Incident Reporting, the injured person is to enter details of the incident onto an Adverse Incident Report Form IR1, which is to be passed to their manager, who is to carry out an investigation and complete the investigation section. All needle stick injuries are to be reported and fully investigated.

In these circumstances, the welfare of the injured member of staff must be given the highest priority, ensuring that all the necessary steps are taken to support them physical and emotional. In order to facilitate that, the Departmental Manager must contact the member of staff at the earliest opportunity and provide the necessary support and advice. Should further information or advice be required, contact the Clinical Executive.


Appendix 5 COSHH Regulations (Adapted from “The Control of Substances Hazardous to Health Regulations” 2002)

The Control of Substances Hazardous to Health Regulations 2002 (COSHH) place a duty on employers to prevent, reduce and control the risk to employees, contractors and members of the public from exposure to substances in the workplace. The regulations cover material containing or emitting chemicals, fumes, dust, vapours, mist and gases. The regulations do not cover lead, asbestos or radioactive materials as these are covered by their own specific regulations.

Hazard Identification (in an office environment)

o Fumes from work equipment during operation (photocopiers, printers, etc). o Use of stationery items (printer cartridges, inks, correction fluid, glues, etc). o Use of cleaning chemicals. o Building Services (fire extinguishers, refrigerant used in air conditioning plant,

maintenance materials, etc). o Construction / refurbishment (construction materials, dust control, etc).

Material Safety Data Sheet (MSDS) Suppliers of substance hazardous to health must produce and supply a safety data sheet for their products. This information will aid employers when carrying out a COSHH risk assessment. The information found on a material safety data sheet will include;-

o Product name and trademark. o Chemical composition. o Physical properties. o Hazards. o Handling and storage. o Recommended procedures in the event of an emergency. o First aid.

Control Measures When a hazardous substance has been identified firstly review the process and try and eliminate the risk completely or if this is not possible try reducing the risk by substituting the product with a safer alternative. Where control measures are required the following should be considered;-

o Personal Protective Equipment (PPE) (gloves, eye protection, etc). o Permits to work. o Monitoring (Work Exposure Limit (WEL)). o Health Surveillance. o Emergency Planning (first aid, spill procedures, etc).

Specific training should then be carried out in the task and any control measures that are required to control the risk. Risk assessment should be reviewed on a regular basis.

EBPCOOH/CG/IR/MB Rev 10 02/2014 Infection Control & Decontamination Policy

Management of needlestick (inoculation) injuries

for East Berkshire Primary Care Out of Hours Service staff in the community This guidance sets out the procedure for the immediate management, and appropriate treatment and follow up of staff who may have been exposed to a blood borne virus during the course of their work. Any staff member who sustains an inoculation injury during the course of their work must following the steps outlined below ensuring the manager/senior member of staff on duty is informed of the incident immediately. What is a inoculation (needlestick) injury? An inoculation injury occurs when a member of staff has a percutaneous or ucocutaneous exposure to blood or bodily fluids from a patient

A percutaneous exposure is where a needle/sharp object that has already been used on a patient, a human scratch or bite has broken the skin. Sharp objects include scalpels, hypodermic needles, suture needles, bone A mucocutaneous exposure is where the mucus membrane i.e. mouth, nose, eyes or non-intact skin have been contaminated by blood or blood stained bodily fluids from a patient.

Actions to take following an Inoculation Injury Wash the site immediately with soap and water, encourage bleeding but do not scrub the area or suck the area. if the eyes have been splashed remove contact lens before washing the affected eye(s) with water. Clean/replace contact lens before reapplying to the eye. Make a note of the patient concerned and their GP, where known. Inform manager / senior member of staff in charge immediately and contact Occupational Health at the Royal Berkshire NHS Foundation Trust on 0118 3227634 during Mon-Fri 8:30am – 4:30pm or outside of these hours contact the A&E Department on 0118 322 7019 Actions to take if the source patient is known The risk assessment form for the source patient at Section 3 should be completed by the manager / senior member of staff on duty in the Practice at the time of the incident. Review the source patient’s file held on record in the Practice to identify if any risk factors are know for blood borne viruses.

Occupational Health Department


Risk factors include,

known hepatitis B, C or HIV infected patients,

known intravenous drug users,

patients from sub Saharan Africa or south east Asia. Please see the HPA website for full list. If the answer is yes to any of the above risk factors HIV Post Exposure Prophylaxis (PEP)may be considered by Occupational Health or A&E. To support the risk assessment process the manager / senior member of staff on duty, should seek consent from the source patient for them to undertake a blood test in conjunction with their GP. This should NOT be done by the injured employee. Informed written consent must be obtained. An information note for source patients is included at Section 1 together with a consent form for blood screening at Section 2 which the source patient should be provided with to bring to their GP for discussion and completion for blood testing. This sample will then be tested for infectivity from Hepatitis B, Hepatitis C (HCV) and HIV. The source patient’s GP will be informed of the results. If the source patient is positive for Hepatitis B,C or HIV follow up blood testing for HIV, Hepatitis C antibody/Hepatitis C RNA and Hepatitis B are recommended at 6 (Hepatitis C RNA only), 12 and 24 weeks for the employee who sustained the inoculation injury. Occupational health will contact the employee to remind them to come in for follow up screening. If contact details are not maintained, Occupational health will attempt contact twice before closing off the case. If Source Bloods are negative, no further follow up is required and Occupational Health will advise the employee. Unknown Source Patient / Consent for blood screen refused Incidents involving the blood of an unknown source, or a source patient refuses consent for testing or the source patient is unable to be tested will all be classed as unknown source status. All incidents where there is an unknown source should be appropriately risk assessed by a competent person. Consideration should be given to whether or not any high risk patients i.e. known hepatitis B, C, HIV positive patients or know IV drug users have recently been treated within the past 1-2 days. However it is uncommon for HIV PEP to be routinely given where a source patient is unknown. In the event the source patient is unable to consent or has left the premises every effort should be made by the Manager / Senior member of staff on duty at the time to gain timely consent by contacting the patient and informing them of the incident and seeking consent as outlined in the section above. Where No source patient bloods have been obtained the injured member of staff will require follow up blood screens at 12 & 24 weeks post the incident for Hepatitis B, C and HIV, These bloods must be taken by the Royal Berkshire NHS Foundation Trust Occupational Health department.


Section 1

INFORMATION FOR SOURCE PATIENT

A healthcare worker involved in your care has been accidentally exposed to your blood or body fluids in a way which could pose a risk to their health if you are infected with Hepatitis B, Hepatitis C or HIV. In order to protect the healthcare worker from this risk, we need to test your blood to see if you are infected with these viruses. We will need a blood sample to do this test. Hepatitis B, Hepatitis C and HIV are not common illnesses, but it is possible to be infected with them without knowing or being ill. If you are infected with these viruses it is important for you to know this as there are treatments available for these conditions. These viruses are transmitted by exposure to blood and some body fluids, most commonly by sexual contact with an infected person or by the sharing of needles between injecting drug users. People who are at higher risk of being infected are for example:

Men who have sex with men

Sexual partners of the above

Injecting drug users

Patients who have had blood transfusions or treatment with blood products.

If none of these risk groups apply to you, the risk of you being found to be infected with Hepatitis B, Hepatitis C or HIV is very low. If one or more of these risk groups apply, you may have a higher chance of being found to be positive on testing. If you know that you are infected with Hepatitis B, Hepatitis C or HIV, please tell us as we may need to act quickly to protect the healthcare worker. You do not have to tell us which group applies to you. If you would like further information about the risk of being infected with Hepatitis B, Hepatitis C or HIV, please ask your GP when discussing your consent for a blood test. Specialist counsellors are also available to discuss the implications of HIV testing if you would like more information. THE STANDARD OF YOUR CARE WILL BE UNAFFECTED WHETHER YOU AGREE OR REFUSE TO UNDERGO THIS TEST. If you agree to a test for Hepatitis B, Hepatitis C and HIV, the results will be given to your GP and to the Occupational Health Department at the Royal Berkshire NHS Foundation Trust who are responsible for the care of the healthcare worker. Your GP will be able to provide you with your results. If it should show that you are infected with one of these viruses, your GP will take the action to ensure the appropriate investigations and treatments are organised for you. If the result is negative, your GP will discuss with you whether or not the test should be recorded in your notes.


Section 2

CONSENT FOR SCREENING FOR BLOOD BORNE VIRUSES FOLLOWING A

BLOOD EXPOSURE INCIDENT TO A HEALTHCARE WORKER.

To: (Source Patients Name):

DoB (dd/mm/yyyy):

Address: (Affix hospital label if available):

A healthcare worker involved in your care has sustained an exposure to your blood or body fluids which may put them at risk if you are infected with Hepatitis B, Hepatitis C or HIV. In order to ensure that the healthcare worker receives appropriate treatment, we need to test your blood to find out if you are infected with these viruses. If you have any reason to believe you may be infected with Hepatitis B, Hepatitis C or HIV, or wish to discuss the implication so having your blood tested for these conditions, please discuss with the doctor before signing this form. Please read the ‘Information for Source Patient’ carefully and discuss in confidence any of the risk factors with your G.P. The results of these blood tests will be given to you by your G.P. They will also be given to the Occupational Health Department at the Royal Berkshire NHS Foundation Trust to help them care for the healthcare worker. The standard of your care will be unaffected whether you agree or refuse to undergo these tests.

I understand that I am being asked to undergo blood testing for Hepatitis B, Hepatitis C and HIV

infectivity. I understand that the results of this test will be given to me. I consent to my blood being

tested for Hepatitis B, Hepatitis C and HIV.

Signed:

Print Name: Date

Print name of G.P discussing consent :

Signature of GP:

Date

Please ensure the blood request form is be clearly marked as the ‘source patient following an inoculation injury’, signed by the GP and marked ‘copy of results to be sent to the Occupational Health Department, Royal Berkshire NHS Foundation Trust’. Please fax this completed source patient consent for screening form to Occupational Health at the Royal Berkshire Hospital on 0118 322 8778


Section 3 SOURCE PATIENT RISK ASSESSMENT FORM

Dental / GP Practice Name:

Contact Number:

Patient Name:

Patient D.O.B:

Country of Origin: GP Name & Contact Details:

SOURCE PATIENT HISTORY

Hepatitis B Yes / No Hepatitis C Yes / No

HIV Yes / No IV Drug Abuse Yes / No

Homosexuality Yes / No Haemophilia Yes / No

Previous Blood Transfusions Yes / No

Other information: e.g. Tattoos; piercings; Patient is not able to give informed consent?

Please explain - Why? When?

History taken by: Job Title:

Date: Time:

Please fax this completed source patient consent for screening form to Occupational Health at the Royal Berkshire Hospital on 0118 322 8778


Actions to take following an inoculation injury

Wash the site immediately with soap and warm water

Encourage bleeding but do not scrub the area or suck the area.

If the eyes have been splashed remove contact lens before

washing the affected eye(s) with water. Clean/replace contact lens

before reapplying to the eye.

Complete source patient risk assessment and fax

completed form to the Occupational Health

Department at Royal Berkshire Hospital on

0118 322 8778

During Monday – Friday (excluding bank holidays) 8:30am -4:30pm

Contact Occupational Health at Royal Berkshire Hospital on 0118 322

7634 and inform them of the incident including the outcome of the

source patient risk assessment (if known).Outside of office hours contact

your local A&E department and contact Occupational Health the next

working day.

Source Patient Known.

Yes No

Provide source patient with information sheet and the

consent form for blood screening to bring to their GP

for discussion when having their blood test

NEEDLESTICK/ SHARPS INJURY

PROCEDURE


Appendix 7 Example Cleaning Schedule

Urgent Care Centre

St Marks Hospital

Daily Cleaning Schedule for Consultation Room 3

December 2013 At the start of each shift the following surfaces must be cleaned with

the appropriate disinfectant wipes supplied:

Work surfaces Telephone Printer Computer Couch Trolley

Fridge Slit Lamp

At the end of the shift please unload the prescription paper from the

printer and store in a locked cupboard

DATE TIME NAME SIGNATURE

01

02

03

04

05

06

07

08

09

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References and Bibliography

NATIONAL PATIENT SAFETY AGENCY. 2009. Revised Healthcare Cleaning Manual [Online]. London: National Patient Safety Agency. Available: http://www.nrls.npsa.nhs.uk/resources/?EntryId45=61830 [Accessed 14/01/2011]. NATIONAL PATIENT SAFETY AGENCY. 2011. Clean Your Hands [Online]. London: National Patient Safety Agency. Available: http://www.npsa.nhs.uk/cleanyourhands/ [Accessed 20/09/2011]. HM GOVERNMENT. 1974. Health and Safety at Work Act 1974 [Online]. London: Her Majesty's Stationary office. Available: http://www.legislation.gov.uk/ukpga/1974/37/contents.

HM GOVERNMENT. 2002. Health and Safety Exectutive, The Control of Substances

Hazardous to Health Regulations [Online]. London: Available:

http://www.legislation.gov.uk/uksi/2002/2677/contents/made

http://www.nrls.npsa.nhs.uk/resources/?EntryId45=61830

http://www.npsa.nhs.uk/cleanyourhands/

http://www.legislation.gov.uk/ukpga/1974/37/contents

http://www.legislation.gov.uk/uksi/2002/2677/contents/made

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