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Infection Prevention & Control General Practice

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Presentation on theme: "Infection Prevention & Control General Practice"— Presentation transcript:

1 Infection Prevention & Control General Practice 2018-19
Phone: |  @ipcnurse Phone: |  This presentation has been designed to be used by WHCCG Primary care IC leads to carry out mandatory training for staff. It is based on the IC policy which was agreed by the IC leads September 2018

2 4,100,000 patients acquire a HCAI in the EU each year
37,000 HCAI deaths (direct consequence) 110,000 additional deaths (contributory) 101 people per day dying as a direct result 301 people indirect deaths Data ECDC accessed 2015

3 Standard precautions and the chain of infection
Infection Prevention Standard precautions and the chain of infection

4 Chain of Infection Infectious Microbe Susceptible Host Reservoir
Bacteria, Fungi, Virus, Prion, Protazoa Reservoir Place where the microbe lives and replicates Such as people, equipment, water, food, animals Portal of Exit Place where the microbe leaves reservoir Such as coughing, sneezing, bleeding, faeces Modes of Transmission Contact (hands, sharps injury), Airborne, vehicle (equipment), Droplet, Insect vector Portal of Entry Entry point such as wound/opening in the skin or mucosa of the mouth Via sutures, catheters, IV lines Susceptible Host Non-immune person, immune deficiency, babies, elderly Hand hygiene, equipment cleaning, isolation, water Vaccination Chain of Infection Asepsis, sharps safety, hand hygiene, equipment cleaning, PPE The chain of infection illustrates that infection transmission can be prevented when transmission precautions are used. Transmission precautions include: PPE, Hand Hygiene, cleaning and decontamination, cough etiquette, sharps safety and isolation precautions Hand hygiene, equipment cleaning, cough etiquette, PPE

5 Standard Infection Control Precautions
Hand hygiene PPE Respiratory etiquette Medical devices Environment Blood & Body Fluid spillages Disposal of waste and sharps Occupational Safety Asepsis Basic IPC measures to reduce the risk of transmission from both recognised and unrecognised sources of infection For use by all staff, in all care settings, at all times and for all patients

6 Infection Prevention Hand Hygiene

7 Your 5 moments for hand hygiene
WHO developed the 5 key moments for hand hygiene to help health care staff to remember when they must do hand hygiene There are other times that staff should also carry out hand hygiene After the toilet Before handling food/medicine Before starting work When leaving work When hands are visibly soiled (use soap and water)

8 Ensure you use soap and water if: your hands are visibly dirty or where you have had contact with a patient who has potentially/confirmed infectious diarrhoea and/or vomiting.

9 Caring for your hands Do not work clinically if you have lesions or cuts (not covered with a waterproof dressing) on you hands or lower arms. Seek advice for skin lesions on your hands/lower arms Regularly use moisturiser to prevent/reduce skin damage from hand hygiene Do not over wear gloves and remove them as soon as possible Alcohol gel is less damaging to the skin than soap and water (in most cases) There is no maximum amount of times that you can use alcohol gel before you need to use soap and water, however when you hands start to feel sticky and grimy from the gel wash your hands with soap and water to remove the excess. Gloves can cause the skin to become moist, which can lead to skin damage

10 Click here to start video
Hand hygiene video Click here to start video Right Click on link – open hyperlink – will open in you tube.

11 Personal Protective Equipment
Infection Prevention Personal Protective Equipment

12 Personal Protective Equipment
Uniform is not part of PPE No nail varnish Footwear – fully enclosed, non-slip, fitted Wash your uniform at 60C Wash separately to non-uniform items No necklaces (choke/scratch risk) Uniform above elbows NICE Infection Guidance Bare Bellow Elbows for hands on consultations (see hand hygiene presentation for more details) No watches, bracelets, stoned rings

13 Personal Protective Equipment
PPE is not a substitute for hand hygiene Single use – single patient use Dependant on the mode of transmission and the risk Remember ‘nothing below the elbow’ Carry out hand hygiene following removal of PPE PPE should be worn to protect yourself from contamination with blood/body fluid.

14 When to wear PPE Assess the risk No blood or body fluid / wounds
No known infection No PPE Blood or body fluids / wounds but low risk of splashing Non sterile gloves & aprons Blood or body fluid / wounds with high risk of splashing Non sterile gloves & apron or gown & eye and face protection

15 Routes of transmission
Aerosol precautions – Unlikely to be required within a general practice setting. Chicken pox or measles (no immunity) FFP3 mask, apron and gloves Droplet precautions – i.e. productive cough, suctioning Face and eye protection, gloves and apron/gown (within 1 metre) Contact and Faecal - Oral precautions Wounds, urine, faeces, blood, sharps equipment Gloves and apron/gown No PPE precautions required. No risk of blood/body fluid contamination ARI – close contact through droplet transmission from coughing and sneezing, direct human to human contact, contaminated surfaces or breathing aerosols – usually generated by medical procedures As you can see the majority of tasks do not require PPE

16 Most health care facilities have reduced the use of latex products.

17 Personal Protective Equipment

18 Personal Protective Equipment
Always ensure that you carry out hand hygiene following the removal of the gloves and then once all items are removed

19 Infection Prevention Cough Etiquette

20 Respiratory Etiquette
Catch it, Bin it, Kill it Protect your self - Have the flu vaccination each year

21 Infection Prevention Cleaning

22 General Cleaning Equipment must be cleaned between use
Record that the equipment has been cleaned– if there’s no record, or you were not the last person to use it, clean it again Detergent Cleaning wipes – general cleaning Chlorine – infection cleaning

23 Environment General everyday cleaning requires detergent and effort.
All rooms and corridors must be cleaned with a suitable detergent and vacuumed regularly (if appropriate) All rooms and corridors should be clutter free to allow effective cleaning All fixtures, fittings and furniture should be maintained in a good condition to allow effective cleaning Clinical areas must be cleaned daily and specific areas cleaned as required i.e. counter tops, examination couches Enhanced cleaning must be undertaken following recognised infection risk or contamination with blood or body fluids Records of cleaning and related audits should be maintained locally.

24 The Importance of Cleaning
3 months - 2 years Clostridium difficile 1-4 weeks Strep pneumoniae 1-2 days Influenza 6 hours RSV How long do pathogens live in the environment. Some pathogens such as C diff can live in the environment for a very long time because they are spore formers which can lay dormant for long periods. Think how many patients you see in 6 hours and how many may at risk if you do not clean equipment after use.

25 Cleaning & Decontamination
Disinfection High Cleaning Sterilization Bioburden All equipment should be cleaned following use. Cleaning is required prior to higher level processes such as disinfection and sterilisation in order to remove debris from the equipment. Reusable items which require disinfection or sterilisation should be avoided where possible - can you use a disposable alternative? Please contact the CCG of you would like advice on cleaning and decontamination of equipment. Zero Exposure Time

26 Single use items If a medical device or item displays the following symbol on the packaging then it is deemed to be single use only. A single-use device is used on an individual patient during a single procedure and then discarded. It is not intended to be reprocessed and used again, even on the same patient. Reusing a single use product may result in the transfer of legal liability for the safe performance of the product from the manufacturer to themselves or employer.

27 Cleaning segregation colours
Reusable mops should be decontaminated in an industrial washing machine ideally daily but a minimum of weekly Disposable mops should be changed ideally daily but a minimum of weekly (if daily is not possible request a change every three days) Mop water should be changed between each room – ensure that waste water is not disposed of down a hand hygiene sink Cloths should be changed between rooms (reusable cloths should be decontaminated after every use) Mops should be hung up to drip dry, ensure they are not touching each other Mop buckets should be cleaned following use Correct sequences of sink cleaning e.g. Clean taps before the rest of the clinical wash-hand basin with the plug hole last;

28 Specimen Handling & Spills
Infection Prevention Specimen Handling & Spills

29 Specimen Handling The patient should label their specimen container before defecation with their name, date of birth and date and time of production. The specimen should then be placed inside a specimen bag and sealed by the patient The patient should be advised to wash their hands thoroughly after defecation before touching the specimen pot and again after inserting the specimen pot into the bag Administration Staff should not be handling specimens; the surgery should have a drop box which is emptied by the Practice Nurses / HCA. General principles Reception staff accepting samples must ask the patient to place their specimen into the box provided Samples should only be accepted where containers are correct and secure in accordance with the above guidelines. Where not, the sample should be refused and a correct container supplied or the patient should be referred back to the appropriate clinician Any staff member who handles vaccinations should be trained in safe handling of specimens Staff who handle specimens or who are expected to clean up a blood/body fluid spills should be vaccinated for Hepatitis B

30 Testing urine samples Gloves
Hard surface Paper towel Detergent wipes Sealed container disposed of in clinical waste bin Do not dispose of urine down the sink Do not dispose of urine down the sink SRCL have indicated that they are happy with the disposal of urine in clinical waste bins as long as the lid has been tightly screwed back on

31 Spills Clean up spills immediately using a spills kit
Always wear PPE, including eye protection as required Where is your spills kit and PPE stored? Staff cleaning up blood/body fluid spills should have Hep B immunity

32 Infection Prevention Sharps Safety

33 Sharps Safety Any incident in which a healthcare worker is stuck by a needle or other sharp instrument which penetrates the skin and which is contaminated with potentially infected blood National Audit Office (2003) -sharps injuries second only to back injuries as a cause of harm to staff – 17% of all injuries Contaminated needles can transmit more than 20 dangerous blood-borne pathogens including HIV, Hep B and Hep C Legal framework (Health and Safety at Work Act (1974), Management of Health and Safety at Work Regulations (1991) Control of Substances Hazardous to Health (2002) reinforce risk assessment and preventative strategies

34 Sharps Safety Hierarchy of Controls
Most effective Hierarchy of Controls Elimination or substitution of sharp (eliminate unnecessary injections) Engineering controls (auto disable syringes, safer needle devices) Training on how to use devices safely Administrative and work practice controls (standard precautions; no recapping; provision and placement of sharps containers) Personal protective equipment (e.g. gloves) Least effective

35 Sharps Safety Sharps must not be passed directly from hand to hand and handling should be kept to minimum Needles must not be bent or broken prior to use or disposal Needles/syringes or needles/vacutainers must not be disassembled or recapped prior to disposal Used sharps must be discarded into an approved sharps container at the point of use These must not be filled above the mark or placed on the floor and the temporary closure mechanism must be engaged Bins must be sealed every 3 months Temporary closure mechanism will stop sharps coming out of the bin if knocked over and will also stop small hands getting into a bin (incident in a hospital where a child thought the sharps bins was a Lego box)

36 Sharps Safety Gloves should be worn as single use items
Needle safety devices must be used where there are clear indications that they will provide safer systems of working for health care personnel Items should not be opened in advance of procedures

37 Examples of incorrect sharps bin use
Over filling of the bin Non sharps items Safer sharps equipment used incorrectly (sheath not deployed after use)

38 Infection Prevention Inoculation Injury

39 Immediately attend your nearest A&E department for treatment
Inoculation Injury ALLOW TO BLEED COVER IT Staff members can be assessed by someone in the practice, however the assessment must be clearly documented and carried out by a qualified member of staff. If there is any doubt regarding the risk, send the person to their nearest ED WASH IT REPORT IT Immediately attend your nearest A&E department for treatment

40 Immediately attend your nearest A&E department for treatment
Splash Injury WASH IT REMOVE IRRIGATE IT REPORT IT Immediately attend your nearest A&E department for treatment Heales Medical sharps injury hotline: Mon-Fri 9am-5pm

41 Infection Prevention Waste

42 Clinical Waste Always make sure that waste bags are labelled with their point of production (tape) Sharps bins should have their label completed on opening and closure

43 Infection Prevention Aseptic technique

44 Aseptic and clean technique
Non touch technique Aseptic technique Routine handwashing and non-sterile gloves and apron Sterile procedure pack, sterile gloves and procedure trolley Intact skin or mucous membranes Skin preparation Hand hygiene with sterile towel or followed by alcohol gel e.g. removal of dirty/used wound dressings Used for short invasive procedure e.g. blood taking e.g. wound dressings e.g. invasive procedures such as minor surgery and joint injections Room with hard flooring and minimal soft furnishings. Risk assess the task that is being performed Protects patients against transmission of organisms from the environment

45 Isolation of potentially infectious patients
Infection Prevention Isolation of potentially infectious patients

46 Isolation Depending on the urgency of consultation, patients with potentially infectious diseases e.g. infectious rashes and vesicles, diarrhoea, vomiting, mumps etc. should be asked to stay at home and telephone triage or home visits used to manage the patient. Where patients do present to the surgery, they should be immediately isolated in Insert practice process, if this is not available in Insert practice process. Environmental cleaning of touch points and surfaces should be undertaken on the patient’s departure.

47 Staff exclusion policy
Infection Prevention Staff exclusion policy

48 Staff exclusion Staff with diarrhoea or vomiting due to infectious causes must be excluded from work until 48 hours after symptoms have resolved. Staff with influenza may return to work once their fever has subsided. Staff with rashes should seek medical diagnosis but stay off work until vesicles (chicken pox) has crusted over. A risk assessment is required for Shingles as staff may be able to work if the vesicles are not on hands, face or neck and they do not have contact with vulnerable patients.

49 Notification of infectious diseases
Infection Prevention Notification of infectious diseases

50 Notification of disease
A number of infectious diseases are statutorily notifiable under the Public Health (Control of Disease) Act 1984 and the Health Protection (Notification) Regulations 2010. Registered medical practitioners have a statutory duty to notify the ‘proper officer’ at their local council or local Public Health England HPT) of suspected cases of certain infectious diseases. Complete a notification form immediately on diagnosis of a suspected notifiable disease. Don’t wait for laboratory confirmation of a suspected infection or contamination before notification. Send the form to the proper officer within 3 days, or notify them verbally within 24 hours if the case is urgent, securely: by phone, letter, encrypted s or secure fax machine Public Health England South East (Wessex Centre) In Hours OOH

51 Infection Prevention Water Hygiene

52 Water Safety Biofilms are common & support bacterial growth

53 Water Safety The following actions should be carried out to ensure that your staff and patients are protected from water borne infections such as Pseudomonas and Legionella Cold water must be 20C or less Hot water tank must be no less than 60C Hot water must be a minimum of 55C at all outlets within 1 minute All staff should identify any infrequently used water outlets Any infrequently used outlets should be flushed for 2 minutes at least weekly (full bore) Identify and remove any dead-legs in the water system Hand Hygiene sinks to only be used for hand hygiene Remove and prevent lime scale build up Ensure that water flushing and temperature checks are documented In the majority of cases culturing your water is unnecessary – contact CCG for advice Do not use the hand hygiene sink for disposal of dirty water or decontamination of equipment Most practices will have relatively simple plumbing systems and will be low risk An underused water outlet is defined as an outlet that is used less than once a week. Flushing of these outlets should occur weekly with the outlet opened full bore for 2-3 minutes. The flushing regime should be documented Make sure staff report outlets that are underused (either because the room use or procedures have changed) Make sure you have a schematic (drawing) of your water supply Measuring water temperatures at the boiler and return is useful as an indicator of water supply temperature Hot water should leave the boiler at 60°C and return at no less than 50°C. Water should come out of the taps at 55◦C (assuming that there is no thermostatic mixer valve) Identify the sentinel outlet (furthest from the boiler) if the water is above 55oC the rest of the taps should also be above 55oC Your hot water should reach the right temperature within seconds of turning the tap on – if it doesn’t, your water system needs further investigation Cold water should be under 20◦C whenever possible

54 Any Questions?


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