Infection prevention and control is an important consideration in all healthcare environments. Patients who are unwell may transmit their infection to others, and some patients are more vulnerable to infections than others. In addition, healthcare workers may need to come into contact with potentially infected body fluids in the normal course of their work.
Non-clinical staff - receptionists, domestic staff and even the person who drops off the mail - may also be at risk from infection. Good infection control policies and practices will minimise the risk to patients, to staff and to others.
Each organisation should have a designated Infection Prevention and Control lead, but all staff should be aware of the relevant policies and protocols.
There is an enormous amount of information available to practices who wish to review their policies, for example in preparation for a CQC inspection - so much so that it can seem overwhelming. Many Local Area Teams or Clinical Commission Groups will have their own policies and protocols, and this can be a good place to start. NICE has also published detailed guidance on prevention and control of healthcare-associated infections in primary and community care.
The CQC requires that healthcare providers adhere to The Health and Social Care Act 2008 Code of Practice on the prevention and control of infections and related guidance. Other legislation, such as the Health and Safety at Work etc Act 1974, and the Control of Substances Hazardous to Health (COSHH) Regulations 2002 will also be relevant.
Pragmatically, it can be helpful to consider a practice's obligations under a number of distinct headings:
This will include simple considerations such as hand hygiene. There should be sufficient basins with suitable taps and dispensers for soap, alcohol rub and paper towels should be filled. Staff should be aware of proper hand washing procedures.
Staff should also be aware of the proper use of aseptic technique, for example in minor surgery, and personal protective equipment - sterile or non-sterile gloves, aprons, goggles or masks - should be available and used when needed.
Sharps, specimens and waste
Sharps should be disposed of safely, and healthcare waste should be dealt with in accordance with local protocols as well as national guidance.
Specimen handling can be problematic. Risks associated with this can be reduced by providing staff and patients with sufficient information, and ensuring that specimens are only presented in the correct type of container, appropriately sealed and labelled. The days of a urine sample in a jam jar should be behind us!
Clinical and non-clinical areas should be kept clean and tidy. Cleaning should include door handles, chairs, toys as well as more obvious areas such as toilets and treatment suites.
It may be helpful to have a formal cleaning regime and schedule in place, and for external contractors to know what is expected from an infection prevention and control perspective.
Staff should be trained to deal with spillages, and untrained staff should know which staff are trained. Protective clothing should be worn, and spillage kits - which can be purchased or made up in house - should be available.
If mercury devices are still in use, a specific policy for dealing with mercury spillage will be necessary. Staff who may be at risk should be offered appropriate immunisation, for example against hepatitis B, and should have access to suitable occupational health advice.
Non-clinical staff - receptionists, domestic staff and even the person who drops off the mail - may also be at risk from infection.
Frequently asked questions:
Here we answer some common questions asked by members at MDU seminars on infection control.
How often should personal clinical equipment like stethoscopes or blood pressure cuffs be cleaned?
One studyi has suggested, 'that the contamination level of the stethoscope is substantial after a single physical examination and comparable to the contamination of parts of the physician's dominant hand.' It further suggested that, 'the stethoscope should be regarded as an extension of the physician's hands and be disinfected after every patient contact'. The best method of disinfection is less clear.
The Medicines and Healthcare products Regulatory Agency (MHRA) notes that both disposable (single patient use) and re-usable blood pressure cuffs are available, and advises that re-usable cuffs should be cleaned in accordance with the manufacturer's instructions.
Should we be wearing aprons as well as gloves for minor surgery or similar procedures?
Yes. NICE recommendsii that a disposable plastic apron is worn if there is a risk that clothing may be exposed to blood, body fluids, secretions or excretions.
Contamination of this nature is a real possibility during minor surgery, fitting of intrauterine contraceptives and similar procedures. The aprons should be single use and disposed of according to the relevant guidance. Consideration should also be given to the use of facemasks or eye protection.
When should a sharps box be disposed of after it has first been used?
Sharps bins must be used only for the disposal of sharps and should be closed temporarily when not in use. They must not be filled above the fill line, and must be disposed of when the fill line is reached, or every three months, whichever is sooner. They should be disposed of by the licensed route in accordance with local policyiii.
What is the guidance of disposing of specimens, such as a urine sample, in the absence of a sluice or 'dirty' sink?
The Department of Health publication Health Technical Memorandum 07-01: Safe management of healthcare waste contains detailed advice on the disposal of all types of clinical waste. Healthcare waste must be segregated immediately by the person generating the waste into appropriate colour coded storage or waste disposal bags or containers defined as being compliant with national legislation and local polices, and should be labeled, stored transported and disposed of in the same way. Local clinical waste disposal providers will be able to provide specific advice.
Can patients take any old medication to a local pharmacy rather than giving it to a GP in a consultation?
Yes. Pharmacies are obliged to accept back unwanted medicines from patients, but not necessarily from GP surgeries or nursing homes. The Local Area Team of NHS England should be able to clarify what arrangements apply locally.
Where can we find a template COSHH assessment form and an infection control risk assessment template?
The Health and Safety Executive has a number of useful resources, templates and other advice in respect of COSHH regulations. Most CCGs, or the Local Area Teams of NHS England are also likely to have guidance regarding infection prevention and control risk assessments.
Individual GP practices may wish to contact their MDU general practice liaison manager, who will be happy to provide more detailed training sessions for all staff on infection prevention and control.
Dr Edward Farnan
MB BCh BAO LLM FRCGP DGM DCH DRCOG
Dr Farnan graduated from Queen's University, Belfast, in 1995 and completed his GP training in Northern Ireland, practising as a principal in general practice in Armagh for 11 years. He also sat on a research ethics committee, and had a particular interest in clinical governance.
See more by Dr Edward Farnan