Management of an outbreak of viral gastro-intestinal illness Antibiotic Prescribing Policy Sepsis

Infection Prevention Solutions

Liquid soap products containing antibacterial agents (as are widely available in supermarkets) are not necessary for routine hand decontamination and should be avoided in health care environments.

Some soap formulations are also available as foams. These are acceptable.

Alcohol based hand sanitiser (gel/rub/foam)

Alcohol-based hand sanitiser products – usually gel / foam are currently recognised as being the primary method of hand decontamination for most health care interventions where rapid hand decontamination is required at the point of use.

Alcohol-based products are also useful where adequate facilities are not available e.g. when caring for service users in their own homes.

Alcohol is inactivated in the presence of organic matter i.e. body fluids etc. and therefore is not to be used on soiled hands. The emollient added to some alcohol sanitisers to counter the drying effect of the alcohol can build up on the skin and some manufacturers recommend that hands are washed with soap and water when the hands feel sticky or after a maximum of 5–10 applications of products to remove residues.

Alcohol-based products should be purchased from an approved supplier of medical products e.g. NHS Supply Chain thus ensuring that an appropriate product suitable for healthcare activities is supplied and of the required strength (usually 70%) and type (usually isopropanol). Alcohol products should be used from wall-mounted dispensers (see below) or can be provided for individual staff use in bottles (“tottles”) that can be attached to uniforms thus ensuring that the product is available at the point of care.

Alcohol is not as effective as soap and water in removing Clostridiodes difficile spores or some viruses including Norovirus and must therefore not be used whilst caring for service users with diarrhoeal illness.

Antiseptic detergent products (e.g. Chlorhexidine, povidone iodine)

These products are designed for use when a higher level of antimicrobial kill is required e.g. when it is necessary to remove / reduce resident as well as transient micro-organisms. This is usually only necessary prior to surgical procedures and certain high risk invasive procedures.

Hand wash facilities:

Soap and alcohol containers / dispensers

All soap and alcohol products should be dispensed from a sealed container which delivers a measured amount of product. The nozzle must be cleaned regularly to prevent clogging and contamination. Open containers and refillable containers must not be used as they can become contaminated with micro-organisms.

Infection Prevention Solutions

Ideally, containers should be wall mounted with a pump-action and operated with heel of hand or wrist, not fingers. Best practice recommendation to minimise the risk of Pseudomonas aeruginosa contamination, is for alcohol gel dispensers to be located at the point of use not at hand wash sinks or alternatively use individual hand sanitiser bottles / tottles.

Paper towels

Good quality, soft, absorbent paper towels should be available for use at all hand wash basins. Towels should be dispensed from wall-mounted dispensers to avoid contamination. NB. Electric hand dryers are not recommended in clinical areas due to the risk of contamination arising from the dissemination of contaminated water droplets during use.

Hand cream

Hand cream should be available for staff use. Ideally, it should be provided in wallmounted dispensers or from a pump-action container. Tubes or jars of hand cream must be avoided as they are easily contaminated. Nozzles must be cleaned regularly to prevent clogging and contamination.

Equipment required for effective hand hygiene in clinical settings

All hand wash basins and taps in clinical areas should conform to the requirements of Health Building Note (HBN) 00-10 Part C: Sanitary assemblies (2013), which outlines the minimum requirements for such equipment. This includes the need for:

• elbow / wrist / automatically operated lever taps • mixer taps ensuring that water is delivered at an appropriate temperature • basins without plugs or overflows • taps that are situated so that water does not flow directly into the waste outlet but are off-set

• The provision of adequate clinical hand wash basins is often overlooked. As a general rule, where-ever clinical care is provided e.g. in a clinical or treatment room as well as in service user / resident rooms then a clinical hand wash basin should be fitted within easy reach of staff at the point of care. Facilities may be shared with the service user but adequate soap and alcohol products, together with hand towels must be provided for staff use. Hand wash basins need to be kept clear to facilitate ease of access and toiletries should be kept to a minimum to reduce the risk of contamination.

The following basic principles apply:

• A clinical hand wash basin compliant with HBN 00-10 Part C should be available where-ever clinical activity takes place including in service users rooms (if clinical care is undertaken in the room)