1. Infection Prevention and Control Update

2.
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.

3. MPS Clinical Risk Assessment Results:
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%

4. Infection Control Statistics
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.

5. What is infection & infection control?
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!!

6.
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

7.
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.

8. Reducing spread of infections
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

9. Standard Infection Control Precautions
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.

10. Standard/Universal Infection Control Precautions
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.

11.
Why SICP?
Why are standard infection control precautions necessary in GP practice?

12.
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

13.
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

14.
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

15. Sharps Disposal Purple Lid - Hormones e.g. Zoladex, BCG
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

16. Waste Disposal Different coloured bags are used for various waste.
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?

17.
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.

18. Hand Hygiene Simple and effective
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

19. Alcohol Gel Used as a compliment to hand washing, not a replacement
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

20.
IPC Website

21.
IPC Website

22. Hand Washing Wet hands, apply soap. Palm to palm.
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.

23. Further Reading NICE infection prevention and control April 2014
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 Code of Practice on the prevention and Control of Infections and Related Guidance.
National Resource for Infection Control.
Infection Prevention Control

24.
Further Reading
Kate Taylor, MPS Clinical Risk Manager, highlights the importance of infection control in general practice
Wipe it out. One chance to get it right. Essential practice for infection prevention and control. RCN publication
Management of waste from health, social and personal care. RCN publication
The selection and use of disinfectant wipes. RCN publication

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