Infection Prevention and Control Update www.clarimed.co.uk

www.clarimed.co.uk Course Aim: To provide information that will ensure, as far as is reasonably possible, an infection free zone for staff and patients Understand the importance of infection control measures in the work place. Understand the essentials of maintaining a clean working environment. Explain and demonstrate effective hand washing techniques.

MPS Clinical Risk Assessment Results: www.clarimed.co.uk MPS Clinical Risk Assessment Results: No Cleaning Schedule Reception staff handling specimens at the desk Hand washing not addressed at the practice Dealing with spillages not addressed No infection control training Clinical waste and sharps not addressed 41% 44% 25% 26.7% 31.7% 5.8%

Infection Control Statistics www.clarimed.co.uk Infection Control Statistics 300,000 patients/year in the NHS acquire HCAI Most common types ; respiratory infections (LRTI & pneumonia), UTIs, surgical site infections. In 2007, 9000 deaths in primary & secondary care attributed to MRSA & CDI However: More recently 18 fold reduction in MRSA infections 5 fold reduction of CDI Gp practice is an healthcare environment and unlike the GP who was quoted in pulse magazine stated that risk no greater than hairdressers. Quote from previous delegate: I have recently worked in an office and it was cleaner than the surgery in which I work now.

What is infection & infection control? www.clarimed.co.uk What is infection & infection control? Infection is caused by pathogenic micro- organisms – any living particle capable of causing disease Infection control refers to policies and procedures used to minimise the risk of spreading infections, especially in hospitals and human or animal health care facilities. What is the greatest infection risk to the patient? Answer The health care worker!!

www.clarimed.co.uk Chain of Infection A useful tool for seeing how to prevent transmission. Identify examples of each of the links within the chain. The transmission of infection depends on six elements which link together like a chain. If any link is broken then the chain is broken and infection cannot be transmitted. The elements are infectious agent, a reservoir for its growth, a portal of exit into the host, and a susceptible host. Virulence (ability to grow and multiply)   Invasiveness (ability to enter tissue)   Pathogenicity (ability to cause disease) The reservoir (Slide No 7 / eLearning Page 6) The reservoir is the site where infectious micro-organisms reside and multiple. This can include:  People  Equipment  Animals  Water  Food  Soil Without reservoirs, infectious agents could not survive and therefore could not be transmitted. An individual does not need to be symptomatic to serve as a reservoir. There are “carrier hosts” who do not show any obvious signs or symptoms of a disease but are still capable of transmitting the disease. Portal of Exit The place of exit provides a way for a micro-organism to leave the reservoir. For example, a micro-organism may leave the reservoir through the nose or mouth when someone sneezes or coughs. Other examples of sites of exit are:  Breaks in skin  Blood  Vomit  Any other bodily substance Portal of Entry This is the site through which the micro-organism enters its new host and cause infection. Infectious agents can enter the body through various portals such as:   Inhalation (breathing in)   Ingestion   Sexual contact   Breaks in the skin   Medical devices such as tubes placed in body orifices (e.g. catheters, needles, IV) Pathogens frequently enter the body of the host via the same route they left the reservoir; for example, airborne infectious agents from one person‟s sneeze can enter through the nose of another person. Transmission This is the method of transfer by which the micro-organism moves or is carried from one place to another. The principal routes of transmission are:   Direct Contact (human to human contact for example through touching, kissing, sexual intercourse or from a pregnant woman to her fetus through the placenta)   Via respiratory droplets when coughing, sneezing or talking   Indirect Contact (For example airborne transmission, contact with contaminated surfaces touched by the infected person, or where droplets of bodily fluid have landed;   Blood exposure   Consuming contaminated food/water   Parasite bites Susceptible host Low immunity   Age (very young or old)   Poor nutritional status – obesity or malnourishment   Underlying disease   Poor personal hygiene   Medication   Surgery   Metabolic disorders   Genetic abnormalities   Not being vaccinated   Pregnancy

www.clarimed.co.uk Chain of Infection Write 2 with line through it. Relating your answers to a GP surgery, what can we do to break this chain? Identify 5-10 hotspots of infection within your given work area.

Reducing spread of infections www.clarimed.co.uk Reducing spread of infections Standard Principles The recommendation on standard principles provides guidance on infection control precautions that should be applied by all healthcare personnel to the care of patients in community and primary care settings. The recommendations are divided into 4 distinct interventions Hand hygiene The use of personal protective equipment The safe use and disposal of sharps and waste Education of patients, their carers and healthcare personnel

Standard Infection Control Precautions www.clarimed.co.uk Standard Infection Control Precautions Standard Infection Control Precautions (SICP) are designed to prevent cross transmission from sources of (potential) infection including: Blood and other body fluid secretions or excretions (excluding sweat, non –intact skin or mucous membranes) and Any equipment or items in the care environment which are likely to become contaminated.

Standard/Universal Infection Control Precautions www.clarimed.co.uk Standard/Universal Infection Control Precautions Standard Infection Control Precautions (SICP) • Hand hygiene, • Personal protective equipment, • Sharps disposal, • Waste disposal, • Linen handling and segregation, • Blood and body fluid spillage procedure, • Handling and transport of specimens, • Decontamination of equipment and the environment.

www.clarimed.co.uk Why SICP? Why are standard infection control precautions necessary in GP practice?

www.clarimed.co.uk Sharps Awareness Following a needle stick injury, risk of infection will depend on number of factors. They include: • The depth of the injury • The type of sharp used (hollow bore needles are higher risk although subcutaneous needles also present a risk) • Whether the device was previously in the patient’s vein or artery • How infectious the patient is at the time of the injury

www.clarimed.co.uk Sharps Awareness When all these factors are taken into account, the risk of infection by a contaminated needle can be as high as (HPA, 2012): one in three for hepatitis B one in 30 for hepatitis C one in 300 for HIV

www.clarimed.co.uk Sharps safety These controls aim to change the behaviour of workers to reduce exposure to occupational hazards. Examples include: no needle recapping or re-sheathing safe construction of sharps containers placing sharps containers at eye level and within arm’s reach disposing of sharps immediately after use in designated sharps containers sealing and discarding sharps containers when they are three-quarters full establishing means for the safe handling and disposal of sharps devices before the beginning of a procedure

Sharps Disposal Purple Lid - Hormones e.g. Zoladex, BCG www.clarimed.co.uk Sharps Disposal Purple Lid - Hormones e.g. Zoladex, BCG Yellow Lid - Vaccines, ampoules containing drugs etc. Orange Lid - Blood letting equipment, stitch cutters & surgical blades, podiatry blades

Waste Disposal Different coloured bags are used for various waste. www.clarimed.co.uk Waste Disposal Different coloured bags are used for various waste. What waste goes in: Black bag? Orange/yellow bags? Yellow boxes? How do we dispose of soiled linen? How do we deal with spillages of body fluids?

www.clarimed.co.uk Waste Disposal Black bag? Couch roll, paper towels, packaging from instruments - recycle where able  Orange bag? Autoclaved waste not incinerated - e.g. for contaminated PPE, dressings, very small tissue samples, syringes used for body fluids Yellow bag? (incinerated) - e.g. infectious clinical waste, medicinally contaminated syringes, medicated dressings (e.g. impregnated with ibuprofen) 4. Yellow/Black bag? (Offensive/hygiene waste) (Landfill) - Feminine hygiene waste, nappies Yellow: infectious waste contaminated with chemicals chemically contaminated samples and diagnostic kits laboratory specimens. Orange:dressings bandages protective clothing (for example, gloves or aprons). Purple medicine containers with residues of cytotoxic or cytostatic medicines used sharps or item e.g. swabs from treatment using cytotoxic or cytostatic medicines. Tiger: stoma or catheter bags incontinence pads hygiene waste gloves, aprons, maternity waste with no infection risk Red:recognisable body parts placenta.

Hand Hygiene Simple and effective www.clarimed.co.uk Hand Hygiene Simple and effective Proven to reduce the risk of acquiring HCAI Use of alcohol gels Performed immediately before and after every episode of direct contact or care Ensure technique is good

Alcohol Gel Used as a compliment to hand washing, not a replacement www.clarimed.co.uk Alcohol Gel Used as a compliment to hand washing, not a replacement Good for rapid disinfection of skin Can only be used on physically clean hands Should only be used up to 5 times then wash hands with soap and water Only effective once alcohol has evaporated from hands

www.clarimed.co.uk IPC Website

www.clarimed.co.uk IPC Website

Hand Washing Wet hands, apply soap. Palm to palm. www.clarimed.co.uk Hand Washing Wet hands, apply soap. Palm to palm. Right palm over left dorsum and left palm over right dorsum. Palm to palm fingers interlaced. It is often overlooked how personal jewellery and clothing can hinder effective hand hygiene. To achieve effective hand hygiene in the workplace, you should comply with the “Bale Below the elbows” dress code. In line with this you should:   Avoid wearing wrist watches or stoned rings   Keep nails short and clean and avoid wearing nail varnish and / or false nails   Cover any cuts with a waterproof dressing   Not wear long sleeves. Alternatively roll up sleeves prior to hand hygiene All staff undertaking duties in clinical areas or with patient contact must comply with the „Bare Below the Elbows‟ dress code. However healthcare workers delivering direct patient care outdoors (e.g. ambulance staff) are still expected to wear long sleeved high visibility clothing in line with health and safety legislation. You should refer to your organisation‟s dress code/uniform policy for clarification and any other requirements. Rotational rubbing, backwards and forwards with clasped fingers of right hand in left palm and vice versa. Backs of fingers to opposing palms with fingers interlocked. Rotational rubbing of right thumb clasped in left palm and vice versa.

Further Reading NICE infection prevention and control April 2014 www.clarimed.co.uk Further Reading NICE infection prevention and control April 2014 National specifications for cleanliness in the NHS: Guidance on setting and measuring performance outcomes in primary care medical and dental premises The Health and Social Care Act 2008. Code of Practice on the prevention and Control of Infections and Related Guidance. www.gov.uk National Resource for Infection Control. www.nric.org.uk Infection Prevention Control www.infectionpreventioncontrol.co.uk

www.clarimed.co.uk Further Reading Kate Taylor, MPS Clinical Risk Manager, highlights the importance of infection control in general practice www.medicalprotection.org.uk Wipe it out. One chance to get it right. Essential practice for infection prevention and control. RCN publication 004166 www.rcn.org.uk Management of waste from health, social and personal care. RCN publication 004187 The selection and use of disinfectant wipes. RCN publication 003873

CMT Clarimed Training Website www.clarimed.co.uk CMT Clarimed Training Website www.clarimed.co.uk Click on resources in top right hand corner Password 2016medical Click on Infection Prevention and Control Click on chosen resource