Diagnostic Services 2022

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Infection Prevention and Control

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Policies and Safe Practice Guidance Manual Diagnostic Services Manual

Infection Prevention Solutions Gordon House 1-6 Station Road Mill Hill London NW7 2JU T: 020 8906 2777 F: 020 8906 2233 E: info@infectionpreventionsolutions.co.uk

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Infection Prevention Solutions

INFECTION PREVENTION AND CONTROL DIAGNOSTIC SERVICES MANUAL POLICIES AND SAFE PRACTICE GUIDANCE CONTENTS Title

Section Number

Policies: Infection Prevention and Control Management Policy Management of COVID-19 Policy Statement Antimicrobial Prescribing Policy Sepsis

1 2 3 4

Safe Practice Guidance – General: Infection Prevention and Control (IPC) Principles – the spread of infection Standard Precautions Hand Hygiene Personal Protective Equipment (PPE) Safe Use and Disposal of Sharps Management of Healthcare Waste Estates and Facilities Management Minor Surgery Environment Environmental Cleaning Spillages of Blood and Body Fluids Laundry Management Pest Control

6 7 8 9 10 11 12 13 14 15 16

Safe Practice Guidance – Clinical: Infections with Specific Alert Organisms Decontamination of Medical Devices Single Use and Single Patient Use Medical Devices Aseptic Technique and care of Invasive Devices Asepsis in Minor Surgical Procedures Collection and packaging of Microbiological Specimens

17 18 19 20 21 22

Safe practice guidance – Personnel: Management of occupational exposure to Blood-Borne Viruses Management of Infections in Staff Vaccination Programme for Staff Uniform and dress code

23 24 25 26

Bibliography

27

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PERSONAL PROTECTIVE EQUIPMENT Personal protective equipment is governed by Health and Safety Legislation including the Personal Protective Equipment Regulations (1992). It aims to prevent the transmission of micro-organisms between patients and staff (NICE 2012; Epic 3 2014). The need to wear PPE will depend upon the potential risks associated with the planned task. It is the members of staffs’ responsibility to assess this risk and decide upon the necessary PPE as appropriate. All blood and body fluids, secretions or excretion are potentially infectious; therefore staff must take reasonable precautions against exposure to these including hazardous chemicals and some pharmaceuticals (RCN 2005, NICE 2012, Health and Safety Executive 1999).

Personal protective equipment (PPE) must be provided when the risk presented by a work activity cannot be adequately controlled by other means. All reasonable steps should be taken to secure the health and safety of employees who use PPE. Personal protective equipment includes (but is not restricted to): • • • • •

gloves water repellent aprons / gowns masks eye protection DS IPC 2022 head and footwear (in theatres etc.)

Risk assessment for PPE The choice of PPE and the selection of appropriate materials must be subject to careful assessment of the activity to be conducted and the anticipated risk of exposure to body fluids, risk of transmission of microorganisms and the risk of contamination.

Many activities pose no risk of exposure to body fluids therefore there will be no need for any PPE. Risk assessment forms an integral part of Health and Safety legislation.

Assess risk of activity

No contact with body fluid

No PPE required

Contact with body fluid

Low risk of splashing

High risk of splashing

Gloves and apron

Gloves, apron, mask and eye protection

This list is by no means exhaustive, instead it offers examples of common support/care activities where blood and / or body fluid exposure may occur and what

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level of protection to be worn. A standard risk assessment must be undertaken to consider the risk of blood and/or body fluid exposure prior to activities

Activity Contact with intact skin.

No visible blood/body fluids, rashes Sterile procedure Contact with wounds, skin lesions Cleaning up incontinence Potential exposure to blood/body fluids e.g. performing suction, cleaning up spillage Venepuncture, cannulation Vaginal examination Applying topical lotions, creams etc Touching patients with unknown skin rash Emptying/changing urinary catheter bags, urinals, bedpans, vomit bowls Handling specimens Handling used instruments Using disinfectants, cleaning agents General cleaning of clinical areas Bed making (gloves and apron to be removed prior to putting clean linen on the bed) Oral care Feeding people Handling waste

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Apron / Gown Facial protection N/A N/A

N/A

Yes Yes

Risk assessment Risk assessment

Yes Yes

Yes

Risk assessment

Yes

Yes

Risk assessment

Yes

Yes

N/A

Yes

Yes N/A

N/A N/A

Yes Yes

Risk assessment Yes

N/A

Yes

Risk assessment

Yes

Yes Yes

N/A N/A

Yes Yes

Yes

Risk assessment

Yes

Yes

Risk assessment

Yes

Yes (for the removal of used/soiled linen only) Yes Yes Yes

N/A

Yes (for the removal of used/soiled linen only) Yes N/A Yes

Risk assessment N/A N/A

Gloves

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Disposable Gloves Glove use has increased significantly since the emergence of HIV and in response to the implementation of standard infection prevention and control precautions to protect both service users and staff from the potential transmission of blood-borne viruses.

However, it must always be remembered that staff have a duty of care to protect their service users from risk as well as a responsibility to protect themselves. Gloves need to be changed between service users and also between tasks for the same service user to ensure that risk of transmission is reduced.

The use of latex-containing products including disposable gloves is the subject of ongoing concern in relation to latex sensitisation/allergy. All health care providers should undertake a risk assessment relating to the provision of latex-free products, to minimise the risk of inadvertent allergic reactions in those service users and staff known to be sensitive to latex, and to prevent the acquisition of a sensitivity reaction in at-risk individuals e.g. those with known skin conditions such as eczema, dermatitis etc. Where risk assessment has been undertaken, a decision may be made to remove from use all latex products and to provide a suitable latex-free alternative. In the case of disposable gloves, a variety of latex-free products are available with the same properties as latex e.g. increased sensitivity, tactility etc. These include products made of nitrile. Guidance from the RCN (in the bibliography) provides further information on this important issue.

In addition to effective hand hygiene, disposable gloves of the recommended type play an important role in reducing the risks of transmission of microorganisms.

Gloves are worn to: •

reduce the likelihood of micro-organisms being transmitted to service users during invasive or other health care activities

•

reduce the likelihood that hands of personnel contaminated with microorganisms from a service user or equipment can transmit these microorganisms to another service user

•

provide a protective barrier and to prevent gross contamination of the hands when anticipating contact with blood, body fluids, secretions, excretions, mucous membranes and non-intact skin

•

protect staff from potentially harmful microorganisms

Disposable gloves are single use items and should be worn for any invasive procedures, contact with sterile sites and non-intact skin or mucous membranes (NICE 2012, Epic 3 2014).

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Glove use Non sterile, powder-free latex or synthetic latex e.g. nitrile and vinyl gloves should be worn whenever contact with body fluids, contaminated equipment, non-intact skin or mucous membranes is anticipated.

Sterile, non-powdered, latex or synthetic latex e.g. nitrile gloves which provide greater dexterity and tactility should be available in a range of sizes for surgical and other invasive procedures requiring sterile gloves.

For the majority of routine clinical tasks good quality vinyl/nitryl gloves provide adequate protection and should be the glove product of choice.

Gloves are not required when handling unsoiled articles or for contact with intact skin in the absence of body fluids.

Gloves must be removed at the end of each individual procedure/care activity, and hands washed thoroughly.

It is essential to keep the time of wearing gloves to a minimum to avoid skin sensitisation and irritation. Staff experiencing skin conditions, which may be exacerbated by glove wearing, should contact Occupational Health or their GP for further advice / assessment.

Double gloving Healthcare workers should only double‐glove when undertaking exposure‐prone procedures (EPPs) not as routine practice. Double gloving may be considered for particular procedures where the perforation of gloves may be anticipated, e.g. orthopaedic surgery, cardiac surgery An EPP is defined as an activity ‘where there is a risk that injury to the healthcare worker may result in exposure of the patient’s open tissue, to the blood of the healthcare worker’ (DOH, 1998).

The use of double gloves is advocated to protect surgeons from blood borne viruses.

The Department of Health also advocate double‐gloving to reduce the likelihood of percutaneous exposure during surgical procedures on patients with blood borne infections.

Double gloving provides an extra layer of protection and has been shown to reduce the number of perforations to inner gloves in all types of surgery. Double gloves may be worn for high risk cases if deemed appropriate. It is known, however, that double gloving reduces hand dexterity and sensitivity.

Sterile double‐gloving systems have been introduced which helps reveal any outer glove puncture. The system consists of two pairs of gloves; a green under‐glove and a standard outer glove. If the outer glove is punctured the inner glove changes colour thus alerting the wearer.

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Disposable plastic aprons The purpose of wearing a disposable plastic apron is to protect firstly the service user who may be susceptible to infection and secondly the wearer from contamination as well as protecting staff uniform / clothing from contamination with body fluids (exception of sweat) or chemicals (NICE 2012, Epic 3 2014). This may include: • • • • •

decontaminating equipment and during environmental cleaning emptying waste bags close contact patient care related activities with potential for exposure to body fluids any invasive diagnostic procedure undertaking activities using Aseptic Non-Touch Technique (ANTT)

Always remove the apron at the end of each care-giving procedure, discard into a waste bag, and wash and dry hands to reduce the likelihood of transferring microorganisms to another site.

The same apron must not be worn between different care-giving procedures or between service users.

Full Body Surgical Gowns

All surgical gowns are classified as medical devices and are controlled by standard EN 13795 (European Committee for Standardisation 2002).

This standard requires that gowns are able to withstand the user performing all that is required from the surgical procedure without compromising the sterile field, and to be resistant to liquid and microbial penetration, with minimal release of particles.

All gowns used in theatres must comply with the specification outlined and should be the wrap around style.

Theatre staff must understand the gown specification, how the gown is unpacked, how the gown is donned and the area of sterility afforded to the wearer once donned.

During Minimal Access Interventions (MAIs) and some minor surgical procedures (where a sterile device is being implanted) or when there is a risk of significant postprocedure infection then it is recommended that a sterile (water repellent) full body gown is worn to minimise the risk of surgical site contamination (Humphreys H., Coia J.E. et al (2012) Guidelines on the facilities required for minor surgical procedures and minimal access interventions Journal of Hospital Infection 80 103 – 109).

Non-sterile full body long-sleeved gowns may, on occasions be required when disposable aprons provide inadequate cover for the procedure or task being performed. For example, when performing a respiratory aerosol generating procedure on someone who may have a respiratory infection such as COVID-19 or Influenza.

Gowns must be removed on completion of a specific procedure / task as per plastic aprons.

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Face masks / eye protection These are worn when there is a possibility of splashing of blood or body fluids, drugs especially cytotoxic, fine particles from aerosolising procedures, contaminated debris splashing into the eyes, mouth or face, or there is a risk of hazardous substances i.e. chemical/detergents into the eyes and/or mucous membranes. Face masks, goggles, visors, safety glasses or shield masks are all suitable products with the most appropriate product being chosen. Regular prescription spectacles are not regarded as eye protection.

If these products are disposable they should be disposed of as clinical waste; if nondisposable, cleaned as recommended in the disinfection policy / manufacturer’s recommendations, usually with detergent and warm water or a combined detergent and disinfectant wipe. Managers should ensure that a range of appropriate items should be readily available for staff use.

In certain circumstances, face masks may need to be of increased efficiency in order to minimise the risk of transmission of highly infectious micro-organisms. These masks contain a particulate filter, and are often referred to as respirator masks.

Current guidance recommends the use of FFP3 respiratory masks which provide 99% particle filtration efficiency. These must conform to European Standard EN149 2001 (box is CE marked) and must be worn when exposed (usually within 1 metre of a patient) and/or when undertaking specific aerosol generating procedures (AGP’s). For a full list of AGP’s please refer to https://www.gov.uk/government/publications/wuhannovel-coronavirus-infection-prevention-and-control/covid-19-infection-preventionand-control-guidance-aerosol-generating-procedures In accordance with Health and Safety regulations, all staff who may be required to wear FFP3 masks must be ‘Fit tested’ to ensure that masks adequately fit the individuals’ face thus minimising the likelihood of infected respiratory droplets leaking through or around the facemask. Staff should also receive training on the safe technique for donning and doffing these masks. Appropriate records must be maintained. Guidance on the use of FFP3 masks may be provided by local specialists e.g., Manufacturer’s representatives, Health and Safety Executive (HSE), UK Heath Security Agency (UKHSA) - see bibliography.

Headwear Is required to be worn in theatre settings and may be appropriate in some clinic settings depending on the procedures being undertaken e.g. minor surgery etc.

Single use, disposable (or launderable) head coverings must be well-fitting and completely cover the hair.

Items should be removed before leaving the theatre/Intervention suite/area.

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Footwear All footwear worn as PPE should be: • Visibly clean, non-slip and well-maintained; • Supporting and cover the entire foot to avoid contamination with blood or body fluids or potential injury from sharps; • Removed prior to leaving the theatre area; • Subject to regular decontamination with a cleaning schedule and responsibility for cleaning assigned.

Donning and Doffing of PPE The order in which PPE is put on (Donning) and taken off (Doffing) is important in order to prevent contamination of the wearer.

The standard sequence for donning should be: Apron (or gown), face mask or respirator, eye protection and finally gloves.

Doffing is carried out in the following order: Gloves, apron (or gown), eye protection, face mask or respirator For further information please refer to: https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attach ment_data/file/932687/PHE_quick_guide_to_donning_doffing_PPE_standard_health _and_social_care_settings.pdf For details of donning and doffing of PPE when undertaking aerosol generating procedures please refer to: https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attach ment_data/file/911333/PHE_COVID19_Donning_Airborne_Precautions_gown_version__003_.pdf https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attach ment_data/file/911334/PHE_COVID19_Doffing_PPE_Airborne_Precautions_gown_version.pdf

Storage of PPE All PPE should be stored appropriately to minimise the risk of contamination prior to use.

PPE should not be stored close to heat sources or in direct sunlight as this may cause the product to degrade and reduce its protective qualities.

Wall-mounted dispensers are available for the hygienic storage and dispensing of both disposable gloves and plastic aprons. These are recommended for use where a high volume and frequent use of PPE is anticipated.

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Care should be taken when removing disposable gloves from boxes in order to minimise the risk of contaminating the contents with unwashed hands.

Expiry dates of stock should be checked regularly / prior to use.

Footnote: NHS England & NHS Improvement have published a national hand hygiene and PPE policy which can be found here: https://improvement.nhs.uk/documents/4957/National_policy_on_hand_hygiene_and_PPE_ 2.pdf

The contents of this local policy reflect the content of the national policy and in addition provide useful guidance to staff on other aspects of PPE.

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