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National Public Health Service Infection Control in General Practice

Quality improvement toolkit for Infection Prevention & Control in

General Practice

Author: Primary Care Quality & Information Service

Date: August 2008

Version: 0i

FINAL Intended Audience: Public (Internet) / NHS Wales (Intranet) / NPHS (Intranet) / LHB / General Practice Purpose and Summary of Document: This document is for the use of General Practice staff in the course of their delivery of high standards in hygiene care and infection control procedures by reducing the risk of Healthcare Associated Infections (HCAI’s) thereby ensuring that patients are cared for in a safe environment. This Quality Improvement tool has been developed as a way to monitor the implementation of infection control standards and guidelines within General Practice settings. Publication and Distribution: Publication in NPHS Document Database (Consultant infection control nurse) Link from NPHS e-Bulletin

Author Primary Care Quality & Information

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Preface

Quality improvement toolkits

The Primary Care Quality and Information Service (PCQIS) have developed quality improvement toolkits to assist practices in collating and auditing information. The quality improvement toolkits produced support the specification requirements of the latest evidence based practice. They should be seen as good practice and cover areas that some or even all practices may not be recording at this stage. It is not expected that all the criteria within the audits will be achieved in year one therefore the PCQIS suggests that the toolkits should be used to aid development within the practice. This toolkit is designed to assist practices with data quality/quality improvement – practices. The PCQIS recognises that some of the criteria in the audit proforma section may involve data that is not currently kept routinely by all practices. Therefore it is recommended that in year one the practice consider recording this information prospectively (using the data entry criteria and suggested read codes provided, so that these criteria can be successfully audited and improvements highlighted over time. You can access other quality improvement toolkits that support enhanced services and National Service Frameworks from the National Public Health Service (NPHS) website: Intranet http://nww2.nphs.wales.nhs.uk/page.cfm?pid=1267Internet http://www.wales.nhs.uk/sites3/page.cfm?orgid=719&pid=23548


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http://nww2.nphs.wales.nhs.uk/page.cfm?pid=1267

http://www.wales.nhs.uk/sites3/page.cfm?orgid=719&pid=23548


CONTENTS Page Preface 3

1 Introduction and background

2 Aim of the quality improvement toolkit 4

3 Methodology 5

4 Data entry template checklist 4.0 Education & Training 6 4.0a Practice Review 7 4.1 Hand Hygiene 8/9 4.1a Practice Review 10 4.2 Treatment Room 11 4.2a Practice Review 12 4.3 Consultation Room 13 4.3a Practice Review 14 4.4 Personal Protective Equipment (PPE) 15 4.4a Practice Review 16 4.5 Prevention of Sharps injuries 17/18 4.5a Practice Review 19 4.6 Specimen Handling 20/21 4.6a Practice Review 22 4.7 Vaccine Transport & Storage 23/24 4.7a Practice Review 25 4.8 Medical Devices 26 4.8a Practice Review 27 4.9 Waste 28/29 4.9a Practice Review 30

5 Hints and tips 31/32

Appendix A – Quality improvement toolkit evaluation form 33 References 34/35/36/37

38/39/40 Background 41/42


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1. Introduction

1The Welsh Healthcare Associated Infections Strategy for Infection Control produced by Welsh Assembly Government (WAG) describes a list of standards and milestones which require primary care to identify and take responsibility to apply best practice as appropriate to the setting to prevent and control healthcare associated infection.

The main objective is to carry out an infection control quality improvement that will meet the requirements of the Welsh Healthcare Associated Infection Strategy 2007. The audit will identify areas of risk within practice, focus on improvements in the transmission of infection by highlighting clean practice environments.

All Primary healthcare staff within practice to understand and discharge their roles and responsibilities in relation to infection control within the clinical governance and risk management framework. Although participation in the toolkit is voluntary, practicing as safely and effectively as possible is not. The Quality Improvement Toolkit is based on best practice but it should be recognised that full compliance may not be currently achieved in all cases. Therefore, if the practice has not fully achieved the criteria we recommend using the PDP facility at each section to monitor progress.

Environment in relation to toilets, reception areas, kitchen area, will be referenced in the clinical governance toolkit Definition of Achieved: criteria met in full: Partially Achieved: criteria only part met Not Achieved: criteria not met Partially Achieved working towards full achievement

2. Aim

To identify the provision and development of infection control requirements across General Practice to see if they are managed appropriately to minimise risk. Practices should regularly audit and peer – review infection control procedures

2.1 Objectives

• To ensure all staff understand the impact of infection control prevention

• To ensure practices have an infection control policy

• To ensure a safe and secure environment to promote best practice


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3. Methodology

3.1 The ongoing management of infection control in General Practice is the responsibility of the General Practitioner and the primary health care team.

3.2 Practices are recommended to complete the Data entry template. It set out a

series of criteria under specified headings 3.3 Practices can audit each specified area at times which suit the practice

infection control management arrangements 3.4 Practices should use the audit results as a basis for discussion by the

Primary Health Care Team (PHCT). The Practice review form will reflect on findings and changes needed to ensure quality improvement

3.5 It is suggested that practices re-audit regularly to ensure that any changes

that the practice considered to be necessary are having a positive effect on infection control procedures



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4. Quality Improvement Toolkit for Control in Primary Care – Data entry template checklist ‘So far as is reasonably practicable, patients, staff and other persons are protected against risks of acquiring HCAIs, through the provision of appropriate care, in suitable facilities, consistent with good clinical practice;’ 2

Please complete as appropriate

Completed forms should be returned to Jo Bloggs, Other LHB

4.0 Education & Training Date of Audit -----------------------------------------

Criteria: Achievedin Full

Action Plan & Partially Achieved

Not Achieved Review Date

1. The Practice can provide evidence of arrangements for management of education and training within its infection control policy 1

2. The Practice has a nominated lead for infection control who should have effective training in place i.e. e-learning 3

3. The Practice provides training in infection control for non clinical and clinical staff at induction and has an ongoing program of training in place1,4

4. Records are kept for all practice staff on infection control education programmes and evidence of relevant continuing professional development (CPD) 1, 5, 6,7

5. The Practice can produce evidence of audit in relation to specific Infection control policies and procedures. 5

6. All Practice polices and procedures for infection control are clearly marked with a review date 1,4

Totals

AIM: All clinical and non clinical staff have training and education in compliance with standard infection control precautions (SICP’s) 1,3,4,5,6,7



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4.0a Practice review A. What lessons did the practice discover from carrying out this audit? B. What changes, if any have the practice agreed to implement as a result of this audit? C. What support would enable the practice to enhance the service it provides to patients? This audit was compiled by;

Name(s) ______________________________________________________ Signature(s) ________________________________________________________ Practice (name and address)

___________________________________________________________________ __________________________________________________________________



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Quality Improvement Toolkit for Infection Control in Primary Care – Data entry template checklist

4.1 Hand Hygiene

AIM: Hands are decontaminated before and after every patient contact 8,9,10,11,12,13,14,15,16,17,18

Date of Audit -------------------------


Partially Achieved

Not Achieved

Action Plan & Review Date

1. The Practice can provide evidence of Hand Hygiene policy 9,11,12,13,17,18

2. All new staff receive training in hand hygiene as part of their induction program 8,9,11,12,13

3. Practice staff have received training in hand hygiene procedures 9,11,12,13

4. Clinical staff have nails that are short, clean and without nail extensions or varnish 9,11,12,13,15

5. Bare below elbow i.e. no wrist jewellery or wrist watches, stoned rings worn during clinical procedures 9,11,12,13,16

Practice Version 0i NHS (Intranet) NPHS (Intranet) / PCQIS / LHB



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4.1 Hand Hygiene continued Criteria: Achieved

in Full Partially Achieved

Not Achieved


6. Posters which are laminated promoting hand hygiene are available and on display in appropriate places 9,11,12,13,14,15,17

7. There is a hand wash basin in each treatment/clinical area which are free from clutter, tablets of soap or nailbrushes

8,9,11,12,13

8. Elbow operated taps are available at all taps in clinical areas i.e. Treatment Room (minor surgery) 8,9,11,12

9. Liquid soap is available at each hand wash basin in wall mounted dispensers using single use cartridge 9,11,12,13

10. Alcohol based hand gels are available for visible clean hands at each clinical area 9,10,11,12,13

11. Paper towels are available in wall mounted containers at all hand wash basins 9, 11,12,13,15,18

12. There is a foot operated bin for waste towels at each hand wash basin in good working order 9,11,12

Totals



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4.2 Treatment Room Date of audit--------------------------------


Action Plan & Partially Achieved

Not Achieved Review Date

1. Disposable paper couch towel is used on examination couch 23,24,25

2. Medical equipment is cleaned and stored appropriately and evidence is available for annual maintenance checks 23, 24,25,26,30

3. Sterile and non-sterile gloves conforming to European standards must be fit for purpose and are available in all clinical areas and in a variety of sizes for single use only with latex- free alternatives available23,24,25

4. Personal protective clothing (PPE) is available and used appropriately as part of practice policy 23,24,25,28

5. Clinical environment is clean and uncluttered with only appropriate furniture in use 19,20,23, 24, 25,26,27, 28,29

6. Rooms where clinical practice takes place have washable floors 19,20,21,22

7. All sterile products must be stored above floor level 23, 24,25

Totals

AIM: Patient care is carried out in an environment that minimises the risk of infection 19,20,21,22, 23, 24, 25, 26, 27, 28, 29, 30



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4.3 Consultation Room

Criteria: Achieved in Full

Partially Achieved

Not Achieved


1. Disposable paper couch towel is used on examination couch 23,24,25

2. Toys are visibly clean with no evidence of soiling and are wipeable or machine washable 23,24,25

3. Furniture, fixtures and fittings are visibly clean with no evidence of soiling or adhesive tape 23,24,25

4. Sterile and non-sterile gloves conforming to European standards must be fit for purpose and are available in all clinical areas and in a variety of sizes for single use only with latex-free alternatives available 23,25

Totals

AIM: Patient care is carried out in an environment that minimises the risk of infection 23,24,25



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uality Improvement Toolkit for Infection Control in Primary Care – Data entry template checklist

4.4 Pers rotective Equipment (PPE) Date of audit-----------------------------------------

Criteria Achievedin Full

Partially Achieved

Not Achieved


1. The p has a comprehensive policy for the appro se of personal protective equipment (PPE)

24,25,3

2. Practi are trained in the use of PPE 32,33

3. Sterile n-sterile (powder free) gloves with latex-free altern vailable are worn as single use items for each clinica dure of patient care 24,25,34

4. Dispo lastic aprons are worn as single-use items for ea al procedure of patient care 24,25,31,35,36

5. Dispo overs are used to protect patients during treatm ,25,33

6. Single cemasks and eye protection are worn where s a risk of splashing (COSHH) 24,25,32,33,35

Totals

AIM: Pe protective equipment is available and used appropriately to reduce the risk of cross infection 31, 32, 33, 34, ,35, 36

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Quality Improvement Toolkit for Infection Control in Primary Care – Data entry template checklist 4.5 Prevention d Management of Sharp Injuries (inoculation injuries) Date of audit-------------------------------------------

AIM: Sharps edlestick injuries, bites and splashes involving blood or other bodily fluid are managed in a way that red s the risk of injury or infection 37, 38, 39, 40, 41 42, 43, 44


Partially Achieved

Not Achieved


1. The practice h e a comprehensive policy for the management sharps / needlestick injuries, bites and splashes 37,3 ,40,44

2. The practice h e arrangements in place to ensure that relevant ff are offered immunisation against Hepatitis B 37 44

3. All practice cl al and non clinical staff receive training in sharps/bite/sp h management and are aware of the actions to tak llowing injury 37,38,39,40,44

4. All needlestic ite/ splash incidents are recorded on an incident fo and also reported according to practice policy 43

5. Sharps conta rs comply with BS 7320(1990)/UN 3291 / 857320 40

6. Sharps conta rs are correctly assembled 39,40

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4.5 Prevention of Sharp Injuries continued Criteria: Achieved


Not Achieved


7. All sharps containers in use are labelled with date, locality and signed 37,40

8. Sharps containers are available at point of use 37,38,39

9. Sharps containers are not to be filled beyond the indicator mark 37,38,39, 43

10. There are no inappropriate items in the sharps container e.g. swabs or packaging 39, 42,43

11. Needles, syringes and equipment used for venepuncture must be single use only and are discarded as a single unit 39,43

12. Full sharps containers are sealed only with the integral lock and not with tape or stickers 40,42,43

13. Unsafe re-sheathing of needles does not occur 39,40

14. Sharps containers must be stored safely away from the public and out of reach of children and off the floor 39,40,42

Totals



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4.5a Practice review

2. What lessons did the practice discover from carrying out this audit? B. What changes, if any have the practice agreed to implement as a result of this audit? C. What support would enable the practice to enhance the service it provides to patients? This audit was compiled by;


___________________________________________________________________



4.6 Specimen Handling AIM: Specimen handling is dealt with promptly and in a way that reduces the risk of cross infection 45, 46, 47, 48, 49, 50

Date of Audit -------------------------------


Partially Achieved

Not Achieved


1. The practice has a comprehensive policy for Specimen Handling 45,46

2. All practice staff handling specimens are trained in spillage, hand washing, PPE, spillage kits 45,49,50

3. Gloves are to be worn by any member of staff who handles clinical specimens – including reception staff 46

4. Specimens that are sent to the microbiology laboratory are in an appropriate container and conform to the current transportation of dangerous good regulations. Those sent in the post should conform to current UN regulation 50

5. Patients are provided with appropriate specimen containers if required to produce specimens at home 46,50

6. Specimens are sealed in designated plastic transit bags and kept in a designated area 45,46,48

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4.6 Specimen Handling continued Criteria: Achieved

in Full Partially

Achieved Not

Achieved Action Plan & Review Date

7. Fridges used for the storage of specimens are not be used to store food or vaccine 45,46,47,48

8. Specimens are transported in leak-resistant containers 50

9. Specimen containers are visibly clean 45,46

10. Specimens tested on site are discarded as per policy 45,46,48

Totals



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4.7 Vaccine transport and storage

Date of audit------------------------------------ Criteria: Achieved


Not Achieved


1. The practice has a comprehensive policy for the storage and transport of vaccines 24,25, 51,52

2. The designated lead has attended regular training which includes guidelines and information on vaccine use, storage and the maintenance of the cold chain 51

3. The practice has a named person responsible for the overall correct use, storage and transport of vaccines 51,52,53

4. Vaccines are stored immediately on delivery into a designated vaccine refrigerator (vaccine storage only COSHH 50) 24,25, 52,53

5. The refrigerator has a thermometer that records min / max temperature within the acceptable range of 2 - 8°C 24,25, 51,53

AIM: Vaccines are stored and transported safely 51, 52, 53


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4.7 Vaccine transport and storage continued Criteria: Achieved


Not Achieved

Action Plan

6. Temperature checks are performed and recorded daily 52,53

7. All vaccines are in date 51,53

8. Vaccine stocks are rotated and used according to date 52,53

9. Vaccines are not stored in the door of the refrigerator or in a separate drawer at the bottom of the fridge 52,53

10. Alternative and appropriate storage is available in the event of a breakdown or repair of the vaccine refrigerator 52,53

11. The practice has a system in place for the safe disposal of expired/surplus/damaged vaccines 52,53

Totals



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Quality Improvement Toolkit for Infection Control in Primary Care – Data entry template checklist 4.8 Medical Devices

Date of audit-----------------------


Partially Achieved

Not Achieved

Not Applicable


1. The practice has a policy in place for the use of disposable equipment 54,56

2. Practices who contract out decontamination services ensures that the CSSD, complies with (MDD) 93/42 EEC and is registered with a MHRA approved body 55,57,58,60,61,62

3. The practice can produce evidence of using a decontamination Process Assessment Tool (PAT) 59

Total

AIM: All risks associated with medical devices are minimised to prevent cross infection 54, 55, 56 57, 58, 59, 60, 61, 62



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Quality Improvement Toolkit for Infection Control in Primary Care – Data entry template check list

4.9 Waste Disposal AIM. The practice has a policy for the safe handling and disposal of waste 63, 64, 65, 66,67,68

Date of audit ------------------------------------

Criteria: Achieved


Not Achieved


1. The practice has a comprehensive policy for the management of waste 63,66,68

2. The practice is registered as a Waste Producer where it generates clin al (hazardous) waste in access of 200kgs in a year 64,67

3. There must be vidence available that the waste contractor is registered w h a valid licence 65,66

4. The practice cl ical and non clinical staff have attended a training sessio on the safe management of waste 63,65

5. All waste bags containers comply with British standards 64,65

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4.9 Waste Disposal continued Actions: Achieved


Not Achieved


6. All clinical waste bins used are foot operated, lidded and in good working order 63

7. All waste bins are visibly clean – externally and internally 63,66

8. Clinical bags / containers are no more than 3/4 full and labelled at source 63,66

9. There is a dedicated area for the safe storage of clinical (hazardous) waste, which is in a secure unit and inaccessible to the public 63,64,67

Totals




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6. Hints & Tips Valid information on infection control for professionals in primary care E-learning Programme This was launched in September 2006 by the Welsh Assembly and forms part of the Strategy for Healthcare Associated Infection. The programme is aimed at health professionals who wish to update themselves and maintain improvements with infection control in their practice. The programme is free to access, and takes about 16-20 hours to complete. Occupational Standards sets out what National Standards are about, list organisations where other relevant standards and guidelines can be found. Designed in partnership with RCN Infection Control National Standards available to support Infection prevention and control ‘Cleanyourhands’ campaign NPSA aims to improve hand hygiene amongst health care workers. There is no simple way of reducing health care associated infections, but improving hand hygiene compliance can have a significant impact. Infection Control at Work A guide for employers and the self employed on identifying, assessing and controlling the risks of infection in the workplace. This guidance can be used if employees come into contact with infectious mico-organisms as a result of the kind of work they do. GMS Contract Management: Practice Guidance page 115 Under the Health and Safety at Work etc Act (1974) (HSWA), GPs are legally obliged to make sure that all employees receive appropriate training and know the procedures for working safely. They must also carry out risk assessments and these could include assessing procedures under the Control of Substances Hazardous to Health Regulations1994 (COSHH). These regulations would cover employees who have direct contact with patients’ blood, other potentially infectious bodily fluids or tissues. Immunisation of doctors and staff that have direct contact with these substances is recommended in the above regulations. Immunisation provides protection in up to 90 per cent of patients vaccinated, but is not a substitute for good infection control procedures. Environment Architects, designers and builders should work with healthcare professionals when planning new facilities. This guidance highlights the major infection control issues, principles can be applied to all healthcare settings Protective Clothing Employers have a responsibility to their staff to ensure that the provision and use of protective clothing reduces risks associated with healthcare infections and their overall compliance with health and safety.


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http://www.skillsforhealth.org.uk/js/uploaded/Appendix E - Guidance and Links.doc

http://www.skillsforhealth.org.uk/js/uploaded/InfectionControlNOS-FinalReport April 2007.doc

http://www.npsa.nhs.uk/cleanyourhands/in-the-community

http://www.dh.gov.uk/dr_consum_dh/groups/dh_digitalassets/@dh/@en/documents/digitalasset/dh_4070103.pdf

http://www.wales.nhs.uk/sites3/Documents/480/QOF Guidance 2008-09 - FINAL VERSION.pdf

http://howis.wales.nhs.uk/sites3/docopen.cfm?orgid=254&ID=49902

http://www.hse.gov.uk/pubns/indg174.pdf


Clinical Equipment process assessment tool (PAT) Decontamination Technical Manual 2001. The PAT forms have been designed to ask a range of questions on decontamination issues. Questions have been taken from required published standards and current best practice NICE Guidance on infection control precautions that apply to all health care professionals in the community. All of the guidance is evidence based. Sharps Needlestick and sharps injuries this guidance provides recommendations on how to minimise and prevent injury. Covers the care given in primary care by health professionals. Documentation of incidents Hazards to health Employers are responsible in providing suitable training and instruction for health care staff who come in contact with substances which present a risk to health. To ensure a suitable record is kept of incidences and is representative of personal exposure Vaccine Handling Vaccines may lose their effectiveness if too hot or cold especially during transport and storage. This guidance set out essentials to follow for correct cold chain compliance Single Use Guidance from the MHRA 2006 on the implications and consequences of single use medical devices. It draws attention to the hazards and risks associated with reprocessing and reusing Waste From July 2005 Hazardous Waste Regulations for England and Wales replaced the Special Waste Regulations.


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Intended Audience: Public (Internet) / NHS (Intranet) NPHS (Intranet) / PCQIS /

LHB

http://howis.wales.nhs.uk/sites3/Documents/254/TechManPt1.pdf

http://www.nice.org.uk/nicemedia/pdf/Infection_control_fullguideline.pdf

http://www2.nphs.wales.nhs.uk:8080/VaccinationsImmunisationProgsDocs.nsf/7c21215d6d0c613e80256f490030c05a/d47969ec4a9de0bf802573790053fcce/$FILE/Innoculation Injury Guidelines.pdf

http://www.opsi.gov.uk/SI/si2002/20022677.htm

http://www.dh.gov.uk/en/Publicationsandstatistics/Publications/PublicationsPolicyAndGuidance/DH_079917?IdcService=GET_FILE&dID=115974&Rendition=Web

http://www.mhra.gov.uk/home/idcplg?IdcService=GET_FILE&dDocName=CON2025021&RevisionSelectionMethod=LatestReleased



Appendix A - Quality improvement toolkit – evaluation form Quality improvement toolkit - evaluation form

The Primary Care Quality and Information Service would like to ensure that the information and suggested tools help practices to monitor and audit their practice data, therefore please could you take a moment and provide your comments on the minor surgery quality improvement toolkit.

1) Did you find the introduction, aims and methodology to be clear and easy to understand? YES NO If No, please comment _____________________________________________ 2) Did you find the organisational checklist to be clear and easy to understand? YES NO If No, please comment _____________________________________________ 3) Did you find the patient audit data proforma easy to use? YES NO If No, please comment _____________________________________________ 4) Did you find the practice review template helpful? YES NO N/A If No, please comment _____________________________________________ 5) Did you find the hints and tips section useful? YES NO N/A If No, please comment _____________________________________________ 6) Did you find the information within the appendices helpful? YES NO If No, please comment _____________________________________________ 7) Do you have any suggestions on how we should improve our quality improvement

Toolkits? ________________________________________________________________ __________________________________________________ __________________________________________________


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References: 1. Healthcare Associated Infections. A Community Strategy for Wales November 2007 WAG http://howis.wales.nhs.uk/doclib/Infections-English.pdfhttp://howis.wales.nhs.uk/keypublications.cfm?sortyear=2007 2. The Healthcare Act 2006: Code of Practice for the prevention and control of healthcare associated infections http://www.dh.gov.uk/prod_consum_dh/idcplg?IdcService=SS_GET_PAGE&ssDocName=DH_081927 Education: 3. NPHS Infection Control E-Learning Package http://www.wales.nhs.uk/sites3/page.cfm?orgid=379&pid=24141 4. NPHS Welsh Healthcare Associated Infection Programme (WHAIP). http://www.wales.nhs.uk/sites/home.cfm?OrgID=379 5. ICNA. Audit Tools for monitoring infection control standards within the community setting, 2005. http://www.icna.co.uk/public/downloads/documents/AuditTools2005.pdf 6. National Occupational Standards for Infection Control Skills for Health. http://www.skillsforhealth.org.uk/ 7. IFH MRSA, Clostridium Difficile and ESBL producing Escherichia coli in the home and community. http://www.ifh-homehygiene.org/2003/2library/MRSA_expert_report.pdf Hand Hygiene: 8. Infection Prevention Society http://www.ips.uk.net/ 9. Infection control Nurses Association 2002 Hand Decontamination Guidelines www.icna.co.uk 10. Girou, E. Loyeau, S. Legrand, P. Oppein, F. Brun-Buisson, C. (2002) Efficacy of handrubbing with alcohol based solution versus standard hand washing with antiseptic soap: randomised clinical trial. BMJ.2002; 325: 362 http://www.bmj.com/cgi/content/full/325/7360/362 11. RCN Good Practice in Infection Prevention and Control 2005 http://www.rcn.org.uk/__data/assets/pdf_file/0003/78654/002741.pdf


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http://howis.wales.nhs.uk/doclib/Infections-English.pdf

http://www.dh.gov.uk/prod_consum_dh/idcplg?IdcService=SS_GET_PAGE&ssDocName=DH_081927

http://www.dh.gov.uk/prod_consum_dh/idcplg?IdcService=SS_GET_PAGE&ssDocName=DH_081927


http://www.wales.nhs.uk/sites/home.cfm?OrgID=379

http://www.icna.co.uk/public/downloads/documents/AuditTools2005.pdf

http://www.skillsforhealth.org.uk/

http://www.ifh-homehygiene.org/2003/2library/MRSA_expert_report.pdf

http://www.ips.uk.net/

http://www.icna.co.uk/

http://www.rcn.org.uk/__data/assets/pdf_file/0003/78654/002741.pdf


12. NICE Infection control, prevention of healthcare-associated infection in primary and community care 2003 http://www.nice.org.uk/guidance/index.jsp?action=byID&r=true&o=10922 13. Healthcare A2Z Hand Decontamination http://healthcarea2z.org/stdPage.aspx/home/Decontamination/CoreContent/Skindecontamination#decontamination 14. National Patient Safety Agency (NPSA) guidelines Cleanyourhandscampaign http://www.npsa.nhs.uk/cleanourhands 15. Evidence Based Practice in Infection Control (EPIC) guidelines http://www.epic.tvu.ac.uk/ 16. World Health Organization (WHO): WHO guidelines on hand hygiene in healthcare (advanced draft): summary - clean hands are safer hands http://www.who.int/patientsafety/events/05/HH_en.pdf 17. Essential steps to safe, clean care. DoH June 2006 http://www.dh.gov.uk/en/Publicationsandstatistics/Publications/PublicationsPolicyAndGuidance/DH_4136212 18. Hand Hygiene Practice Policy 2008. Portway Surgery, 1 The Portway, Porthcawl. Treatment / Consultation Areas: 19. Environmental Cleaning http://www.nyypct.nhs.uk/AdviceInformation/InfectionControl/docs/policies/B6%20Environmental%20Cleaning.pdf 20. Infection Control in the Built Environment http://www.wales.nhs.uk/sites3/Documents/254/InfCtrl.pdf http://howis.wales.nhs.uk/sites3/Documents/254/InfectControl2nded.pdf 21. WHC 2002 (116) Environmental Management Policy for the NHS Estate. http://howis.wales.nhs.uk/doclib/whc2002-116-e.pdf 22. Primary and Social Care Premises Planning and Design Guidance. http://www.primarycare.nhsestates.gov.uk/secure/content.asp 23. Health & Safety Manual for Practice Nurses


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http://www.nice.org.uk/guidance/index.jsp?action=byID&r=true&o=10922

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

http://www.epic.tvu.ac.uk/

http://www.who.int/patientsafety/events/05/HH_en.pdf

http://www.dh.gov.uk/en/Publicationsandstatistics/Publications/PublicationsPolicyAndGuidance/DH_4136212


http://www.nyypct.nhs.uk/AdviceInformation/InfectionControl/docs/policies/B6 Environmental Cleaning.pdf

http://www.nyypct.nhs.uk/AdviceInformation/InfectionControl/docs/policies/B6 Environmental Cleaning.pdf

http://www.wales.nhs.uk/sites3/Documents/254/InfCtrl.pdf

http://howis.wales.nhs.uk/doclib/whc2002-116-e.pdf

http://www.primarycare.nhsestates.gov.uk/secure/content.asp


http://nww2.nphs.wales.nhs.uk:8080/primarycareqitdocs.nsf/7c21215d6d0c613e80256f490030c05a/bae276ef4856f6e58025717200500d93/$FILE/H&S%20Manual%20for%20GMPs%20.May06.doc 24. RCN Good Practice in Infection Prevention and Control 2005 http://www.rcn.org.uk/__data/assets/pdf_file/0003/78654/002741.pdf 25. NICE Infection control, prevention of healthcare-associated infection in primary and community care 2003 http://www.nice.org.uk/guidance/index.jsp?action=byID&r=true&o=10922 26. IFH MRSA, Clostridium Difficile and ESBL producing Escherichia coli in the home and community. http://www.ifh-homehygiene.org/2003/2library/MRSA_expert_report.pdf 27. National Resource for Infection Control. http://www.nric.org.uk/IntegratedCRD.nsf/NRIC_Home1?OpenForm 28. Health & Safety at Work Act (1974). http://www.healthandsafety.co.uk/haswa.htm 29. National Assembly for Wales. Improving Health in Wales - A Plan for the NHS and its partners, (2001). http://www.wales.nhs.uk/Publications/NHSStrategydoc.pdf 30. DOH. Essential steps to safe, clean care: introduction and guidance. http://www.dh.gov.uk/en/Publicationsandstatistics/Publications/PublicationsPolicyAndGuidance/DH_064815 Personal Protective Equipment (PPE): 31. Protective clothing: Principles and Guidance. ICNA, April 2002 www.icna.co.uk 32. Personal Protective Equipment Act http://www.hse.gov.uk/lau/lacs/68- 2.htm 33. HSE. Personal Protective Equipment at Work - Guidance on regulations. http://www.hse.gov.uk/pubns/indg174.pdf 34. Infection Control Nurses Association 2002 A Comprehensive Gloves Choice www.icna.co.uk 35. Health & Safety Manual for Practice Nurses


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http://nww2.nphs.wales.nhs.uk:8080/primarycareqitdocs.nsf/7c21215d6d0c613e80256f490030c05a/bae276ef4856f6e58025717200500d93/$FILE/H&S Manual for GMPs .May06.doc




http://www.nice.org.uk/guidance/index.jsp?action=byID&r=true&o=10922

http://www.ifh-homehygiene.org/2003/2library/MRSA_expert_report.pdf

http://www.nric.org.uk/IntegratedCRD.nsf/NRIC_Home1?OpenForm

http://www.healthandsafety.co.uk/haswa.htm




http://www.hse.gov.uk/lau/lacs/68- 2.htm

http://www.hse.gov.uk/pubns/indg174.pdf



http://nww2.nphs.wales.nhs.uk:8080/primarycareqitdocs.nsf/7c21215d6d0c613e80256f490030c05a/bae276ef4856f6e58025717200500d93/$FILE/H&S%20Manual%20for%20GMPs%20.May06.doc 36. Infection Control & Instrument Sterility for Minor Surgery http://www.patient.co.uk/showdoc/40024534 Sharps injuries: 37. The management of health, safety and welfare issues for NHS staff, 2005 Blue Book Needlestick guidance Chapter 19 http://needlestickforumnet.site.securepod.com/saferneedles/downloads/needlestickmanagementguidance.pdf 38. All Wales inoculation injury guidelines for primary care 2006 http://www2.nphs.wales.nhs.uk:8080/VaccinationsImmunisationProgsDocs.nsf/7c21215d6d0c613e80256f490030c05a/d47969ec4a9de0bf802573790053fcce/$FILE/Innoculation%20Injury%20Guidelines.pdf 39. Infection Control Nurses Association 2003 Reducing Sharps Injury Prevention and Risk Management www.icna.co.uk 40. Medical Devices Agency (2001a) NHS Management Executive The Safe Use and Disposal of Sharps. MDA SN 2001 (19) MDA. London www.mhra.gov.uk – document has been withdrawn not been updated. Health and Safety Executive if you require further information on this subject. The HSE can be contacted on 0845 345 005 or email [email protected]. Below needlestick injury guidance http://www.hse.gov.uk/healthservices/needlesticks/ 41 Health Protection Agency Examples of good and bad practice to avoid sharps injuries http://www.hpa.org.uk/webw/HPAweb&HPAwebStandard/HPAweb_C/1195733815952?p=1191942146594 42. National Standards for Cleanliness: http://new.wales.gov.uk/about/departments/dhss/publications/health_pub_index/guidance/national_standards_cleanliness?lang=en 43. The Reporting of Injuries, Diseases and Dangerous Occurrences Regulations1995. (RIDDOR) http://www.opsi.gov.uk/SI/si1995/Uksi_19953163_en_1.htm http://www.wales.nhs.uk/sites3/documents/245/adverseincidents.pdf http://hygienia.hsw.wales.nhs.uk/live/index.php?form_id=2&module=INC 44. Management of Occupational and Non – Occupational Exposures to


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http://www.patient.co.uk/showdoc/40024534

http://needlestickforumnet.site.securepod.com/saferneedles/downloads/needlestickmanagementguidance.pdf

http://needlestickforumnet.site.securepod.com/saferneedles/downloads/needlestickmanagementguidance.pdf





http://www.mhra.gov.uk/

mailto:[email protected]

http://www.hse.gov.uk/healthservices/needlesticks/

http://www.hpa.org.uk/webw/HPAweb&HPAwebStandard/HPAweb_C/1195733815952?p=1191942146594

http://www.hpa.org.uk/webw/HPAweb&HPAwebStandard/HPAweb_C/1195733815952?p=1191942146594

http://new.wales.gov.uk/about/departments/dhss/publications/health_pub_index/guidance/national_standards_cleanliness?lang=en

http://new.wales.gov.uk/about/departments/dhss/publications/health_pub_index/guidance/national_standards_cleanliness?lang=en

http://www.opsi.gov.uk/SI/si1995/Uksi_19953163_en_1.htm

http://www.wales.nhs.uk/sites3/documents/245/adverseincidents.pdf

http://hygienia.hsw.wales.nhs.uk/live/index.php?form_id=2&module=INC


Bloodborne Viruses October 2007 www.nhsggc.org.uk/phpu Specimen Handling: 45. PCQIS Minor Surgery: Quality Improvement Toolkit July 2006 http://www2.nphs.wales.nhs.uk:8080/PrimaryCareQITDocs.nsf/($all)/253EA03C13014BF0802571C4003AE68B/$file/Minor%20Surgery%20web%20July%2006.doc 46. Leicestershire Primary Care Trust. Infection Control Policy. Specimen collection, handling and transport Sept 2006 http://www.lcrpct.nhs.uk/site/Internet/PoliciesAndProcedures/Clinical/InfectionControlPrimaryCare/0/CH%20PC107%20Specimens%20Policy%201.pdf 47. NPHS. Directed Enhanced Service Minor Surgery, Oct 2006. http://nww2.nphs.wales.nhs.uk/page.cfm?pid=1267 48. Finn, L and Crook, S. Minor surgery in general practice - setting the standards. Journal of Public Health Medicine, 1998, 20 (2), 169-174. 49. Infection A2Z Community practitioner and Health Visitors http://www.healthcarea2z.org/ditem.aspx/286/Specimen+collection/ 50. Control of Substances Hazardous to Health Regulations 2002 http://www.opsi.gov.uk/SI/si2002/20022677.htm http://www.wales.nhs.uk/sites3/documents/245/adverseincidents.pdf Vaccine Storage and Transport: 51 RCN UK Guidance on Best Practice in Vaccine Administration 2001 http://www.rcn.org.uk/__data/assets/pdf_file/0010/78562/001981.pdf http://64.233.183.104/search?q=cache:GJJg6v8x-KEJ:www.rcn.org.uk/__data/assets/pdf_file/0010/78562/001981.pdf+Vaccine+storage+and+Transport+in+General+Practice&hl=en&ct=clnk&cd=17&gl=uk 52. Green Book: Chapter 3: Storage, distribution and disposal of vaccines http://www.dh.gov.uk/en/Publicationsandstatistics/Publications/PublicationsPolicyAndGuidance/DH_079917 53. Advisory Document on Handling & Storage of Vaccines http://howis.wales.nhs.uk/sites3/Documents/474/vaccinedocument4threvisionMay2006.doc


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http://www.nhsggc.org.uk/phpu

http://www2.nphs.wales.nhs.uk:8080/PrimaryCareQITDocs.nsf/($all)/253EA03C13014BF0802571C4003AE68B/$file/Minor Surgery web July 06.doc



http://www.lcrpct.nhs.uk/site/Internet/PoliciesAndProcedures/Clinical/InfectionControlPrimaryCare/0/CH PC107 Specimens Policy 1.pdf

http://www.lcrpct.nhs.uk/site/Internet/PoliciesAndProcedures/Clinical/InfectionControlPrimaryCare/0/CH PC107 Specimens Policy 1.pdf

http://nww2.nphs.wales.nhs.uk/page.cfm?pid=1267

http://www.healthcarea2z.org/ditem.aspx/286/Specimen+collection/


http://www.wales.nhs.uk/sites3/documents/245/adverseincidents.pdf

http://64.233.183.104/search?q=cache:GJJg6v8x-KEJ:www.rcn.org.uk/__data/assets/pdf_file/0010/78562/001981.pdf+Vaccine+storage+and+Transport+in+General+Practice&hl=en&ct=clnk&cd=17&gl=uk





http://howis.wales.nhs.uk/sites3/Documents/474/vaccinedocument4threvisionMay2006.doc

http://howis.wales.nhs.uk/sites3/Documents/474/vaccinedocument4threvisionMay2006.doc


Medical Devices: 54. DB2006 (04) Single Use Medical Devices: Implications & Consequences of Reuse http://www.mhra.gov.uk/home/idcplg?IdcService=SS_GET_PAGE&useSecondary=true&ssDocName=CON2024995&ssTargetNodeId=572http://www.mhra.gov.uk/Publications/Safetyguidance/DeviceBulletins/CON2024995 55. Decontamination / Sterilisation of Re-usable Instruments in General Practice CMO 2004 http://new.wales.gov.uk/docrepos/40382/cmo/comms/letters/2004/2004-13-e.pdf?lang=en 56. National Decontamination Programme 2008 http://www.dh.gov.uk/en/Managingyourorganisation/Leadershipandmanagement/Healthcareenvironment/NHSDecontaminationProgramme/DH_077640 57. HTM 2010 Good Practice Guide: Sterilisation - NHS Estates. http://www.wales.nhs.uk/sites3/docmetadata.cfm?orgid=254&id=66760 58. Good Practice Guide: Washer-Disinfectors. Operational Management. http://www.wales.nhs.uk/sites3/Documents/254/SnHTM2030Op0113220707.pdf 59. Decontamination technical manual Part 1: Process Assessment Tool

(PAT) version 1.0 http://www.dh.gov.uk/en/Publicationsandstatistics/Publications/PublicationsPolicyAndGuidance/DH_4121070http://howis.wales.nhs.uk/sites3/Documents/254/TechManPt1.pdf

60. Medical Advisory Committee (MAC) guidelines sterilisation, disinfection and cleaning of medical equipment. DOH 2005 ISBN 1-85-839518-6 http://www.library.nhs.uk/GuidelinesFinder/ViewResource.aspx?resID=144085http://www.nric.org.uk/IntegratedCRD.nsf/b4a7c3921a8b145c8025711400452d4c/9F315F26DA9BE38F802571A70040498A?OpenDocument 61. Decontamination of re-usable medical devices in primary, secondary & tertiary care sectors 2007 http://www.dh.gov.uk/en/Publicationsandstatistics/Publications/PublicationsPolicyAndGuidance/DH_074722 62. MHRA Sterilisation and Decontamination of Medical Devices.


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http://www.mhra.gov.uk/home/idcplg?IdcService=SS_GET_PAGE&useSecondary=true&ssDocName=CON2024995&ssTargetNodeId=572

http://www.mhra.gov.uk/home/idcplg?IdcService=SS_GET_PAGE&useSecondary=true&ssDocName=CON2024995&ssTargetNodeId=572

http://www.mhra.gov.uk/Publications/Safetyguidance/DeviceBulletins/CON2024995

http://www.mhra.gov.uk/Publications/Safetyguidance/DeviceBulletins/CON2024995

http://new.wales.gov.uk/docrepos/40382/cmo/comms/letters/2004/2004-13-e.pdf?lang=en

http://new.wales.gov.uk/docrepos/40382/cmo/comms/letters/2004/2004-13-e.pdf?lang=en

http://www.dh.gov.uk/en/Managingyourorganisation/Leadershipandmanagement/Healthcareenvironment/NHSDecontaminationProgramme/DH_077640

http://www.dh.gov.uk/en/Managingyourorganisation/Leadershipandmanagement/Healthcareenvironment/NHSDecontaminationProgramme/DH_077640

http://www.wales.nhs.uk/sites3/docmetadata.cfm?orgid=254&id=66760

http://www.wales.nhs.uk/sites3/Documents/254/SnHTM2030Op0113220707.pdf

http://www.wales.nhs.uk/sites3/Documents/254/SnHTM2030Op0113220707.pdf



http://howis.wales.nhs.uk/sites3/Documents/254/TechManPt1.pdf

http://www.library.nhs.uk/GuidelinesFinder/ViewResource.aspx?resID=144085

http://www.library.nhs.uk/GuidelinesFinder/ViewResource.aspx?resID=144085

http://www.nric.org.uk/IntegratedCRD.nsf/b4a7c3921a8b145c8025711400452d4c/9F315F26DA9BE38F802571A70040498A?OpenDocument

http://www.nric.org.uk/IntegratedCRD.nsf/b4a7c3921a8b145c8025711400452d4c/9F315F26DA9BE38F802571A70040498A?OpenDocument




http://www.mhra.gov.uk/home/idcplg?ldcService=SS_GET_PAGE&useSecondary=true&ssDocName=CON007438&ssTargetNodeld=575 Waste Disposal: 63. DoH HTM 07 – 01 Safe Management of Healthcare Waste (Nov 2006) http://www.dh.gov.uk/en/Publicationsandstatistics/Publications/PublicationsPolicyAndGuidance/DH_063274 64. The Hazardous Waste (England and Wales) Regulations 2005 http://www.opsi.gov.uk/SI/si2005/20050894.htm 65. The Waste Management (England and Wales) Regulations 2006 http://www.opsi.gov.uk/si/si2006/20060937.htm 66. Healthcare Waste Strategy for Wales Guidance (Nov 2006) http://www.wales.nhs.uk/documents/WHC_2006_043.pdf 67. Environment Agency – Clinical Waste http://www.environment-agency.gov.uk/commondata/acrobat/sr2008no25_75kte_2004593.pdf http://www.netregs.gov.uk/netregs/sectors/1844747/1844821/1864776/ 68. Safe Management of healthcare waste 2007 http://www.rcn.org.uk/__data/assets/pdf_file/0013/111082/003205.pdf


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http://www.mhra.gov.uk/home/idcplg?ldcService=SS_GET_PAGE&useSecondary=true&ssDocName=CON007438&ssTargetNodeld=575

http://www.mhra.gov.uk/home/idcplg?ldcService=SS_GET_PAGE&useSecondary=true&ssDocName=CON007438&ssTargetNodeld=575




http://www.opsi.gov.uk/si/si2006/20060937.htm

http://www.wales.nhs.uk/documents/WHC_2006_043.pdf

http://www.environment-agency.gov.uk/commondata/acrobat/sr2008no25_75kte_2004593.pdf

http://www.environment-agency.gov.uk/commondata/acrobat/sr2008no25_75kte_2004593.pdf

http://www.netregs.gov.uk/netregs/sectors/1844747/1844821/1864776/



Background information: Healthcare Associated Infections. A Community Strategy for Wales November 2007 WAG Strategic Objectives

• All staff will understand the impact of infection and infection prevention and control practices to enable them to discharge their personal responsibilities to patients, other staff, visitors and themselves.

• Patients will be treated in physical environments that minimise the risk of

infection.

• Organisations will develop an audit programme based on local need and making use of recognised audit tools. Results of audit will be used to inform the development of an infection control programme which will incorporate regular audit and surveillance initiatives.

• Specialist epidemiological advice will be available to support

organisations’ infection control processes and programmes.

• The aim of minimising HCAIs should be embedded within overall management schemes and will have links to clinical governance, risk management and performance management.

• Organisations will develop systems to agreed national standards to

ensure effective recording, analysis, sharing and access to their own data, and access to information sources appropriate to their needs for managing infection within their organisation.

• All staff working within community healthcare settings should have

access to appropriate occupational health services. This Strategy has been developed with a view to highlighting best practice, which is set out in the Welsh Assembly Government’s 10 year strategy, ‘Designed for Life’ (2005) The 1000 Lives campaign aims to engage all LHB’s in Wales to improve patient safety. It will work in Reducing Healthcare Associated Infections. The LHB will be expected to progress initiatives designed to improve control of infection measures in primary care settings. These initiatives will identify evidence based interventions and working practices which the LHB will adopt in conjunction with primary care contractors. All Wales 1000 Lives Campaign


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http://new.wales.gov.uk/dphhp/publication/protection/communicable-disease/haistrategy/hia-strategy-e.pdf?lang=en

http://www.wales.nhs.uk/documents/designed-for-life-e.pdf

http://www.wales.nhs.uk/sites3/docopen.cfm?orgid=270&id=91742&05A01EA3-1143-E756-5C667A2395286F2C


Contractual and Statutory Requirements – Quality and Outcome Framework 2006/2007 The premises, equipment and arrangements for infection control and decontamination meet the minimum national standards Local policies and procedures should include reference to: • Hand hygiene 9,14,15,16,17,24

• Personal protective equipment 24, 31,32, 34

• Decontamination of care equipment 53, 60

• Cleanliness of the environment 19, 21, 23, 24

• Safe handling of linen Linen is handled and managed appropriately to prevent cross infection: Health Service Guideline (95)18 (currently under review)

• Aseptic technique 1,2,9, 15, 24, 30, 36, 48

• Placement/isolation of patients 14, 24, 25, 28 • Safe handling & disposal of sharps 24,25, 37,38

• Hazardous/Clinical Waste 64.67,68

• Prevention of occupational exposure to blood borne viruses (bbvs) 44, 46, 49

• Management of occupational exposure to bbvs and post exposure prophylaxis (PEP) 43, 44, 49

• Control of Infections with specific alert organisms e.g. MRSA, TB, avian influenza, bbvs; 26

• Major outbreaks of communicable disease e.g. diarrhoeal disease. The LHBs and individual organisations should also have in place a policy for the recognition and management of outbreaks of infection. The Welsh Assembly Government has published a ‘Framework for Managing Major Infectious Disease Emergencies: http://new.wales.gov.uk/topics/health/protection/communicable-disease/flu/?lang=en Risk Management:The Manager at the practice will co-ordinate with the lead clinician on all areas of infection control, and production of appropriate policies. Geraint Lewis Risk Adviser [email protected] Risk Training Presentation 1 http://nww2.nphs.wales.nhs.uk:8080/primarycareqitdocs.nsf

Copyright: © Primarycare Quality & Information Service


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http://www.wales.nhs.uk/sites3/Documents/480/Annex1_Quality_and_Outcomes_Framework-Guidance.pdf

http://www.silverguard.co.uk/static/contentfiles/pdf/hsg9518.pdf

http://www.cardiff.gov.uk/content.asp?Parent_Directory_id=2865&nav=2870,3142,3174,4993

http://new.wales.gov.uk/topics/health/protection/communicable-disease/flu/?lang=en

http://new.wales.gov.uk/topics/health/protection/communicable-disease/flu/?lang=en

http://howis.wales.nhs.uk/sites3/page.cfm?orgid=719&pid=21100

mailto:[email protected]

http://nww2.nphs.wales.nhs.uk:8080/primarycareqitdocs.nsf