Icc manual dentistry by Karen Foulis

Environmental Cleaning Policies & Procedures Manual Including Infection Control for housekeeping staff Dentistry

Infection Control Cleaning Management Gordon House, Station Road, Mill Hill, London NW7 2JU Telephone: 020 8906 2777

i www.infectioncontrolcleaning.co.uk

ISO 9001 REGISTERED FIRM

INTERNATIONAL ACCREDITATION BOARD

Certificate No. GB2001573

Registration No. 0044/1

Content

General

1 2 3 4 5 6 7 8 9 10

Introduction Aims Legal Framework Roles and Responsibilities Risk assessment Clothing and Jewellery Safe Manual Handling Health and Safety Record Keeping Training

Section 2

Cleaning Equipment and Chemicals

1 2 3 4 5 6 7 Appendix 1 Appendix 2

Storage Colour Code for Hygiene Cleaning Equipment Microfibre Cleaning Chemical Hazards Table of Types of Cleaning Chemicals Safety Precautions Common detergents, combined agents and disinfectants used in healthcare. Sample Risk Assessment

Section 3

Infection Prevention & Control

1 2 2.1 2.2 2.3 2.4 2.5 2.6 Appendix 1 Appendix 2 Appendix 3

Chain of Infection Infection Prevention and Control Principles Environment Hand Decontamination Personal Protective Equipment Waste Management Accidental exposure to blood/body substances Blood/Body fluid spillage management Hand Decontamination Technique Colour Coded Waste Segregation Action following needlestick / sharps / splash injury

Section 1

xxxxxx Issue Date: 00/00/0000 Review Date: 31/05/2016

Cleaning Specification

Section 5

Cleaning Schedules

Section 6

Method Statements

Section 7

Auditing and Monitoring

Section 8

Glossary

Section 9

References

Section 4

xxxxxx Issue Date: 00/00/0000 Review Date: 31/05/2016

Section 1: General 1. Introduction:

Clean, safe premises are an essential component of quality health care and are of increasing importance to patients and the public. Good housekeeping and a clean, tidy environment reflect the standards of care maintained within your premises, this is important in securing and maintaining public confidence in the service you provide. The issues related to cleanliness and infection prevention and control will feature significantly in commissioning arrangements and local performance management mechanisms.

The Care Quality Commission (CQC) will continue the inspection programme to ensure that healthcare providers are meeting the requirement of regulation with respect to healthcare associated infections. In order to meet these requirements, healthcare providers are expected to provide and maintain a clean and appropriate environment that facilitates the prevention and control of healthcare associated infections. It is important that there is a clear and publicised cleaning responsibility framework and that this is tested and reviewed to ensure that it is fit for purpose (NPSA 2009) 2. Aims

The aim of this manual is to facilitate the delivery of a high standard of cleanliness. Service Users should be treated in a clean and safe environment with minimum exposure to healthcare associated infections (HCAIs) therefore keeping your practice clean and preventing infections is everybody’s responsibility. In addition it should be noted that: •

•

• •

The roles and responsibilities for cleaning are linked to infection prevention and control, and underpinned by strong, clear leadership that encourages a culture where cleanliness is important A well maintained, clean and safe environment, using the most up to date appropriate cleaning products and methods must be provided The cleanliness and performance is constantly reviewed and improved where necessary a structured and proactive education and training program must be provided; to ensure that all your staff are competent in the delivery of infection prevention and control practices within the remit of their role Any persistent failings with regards to cleanliness are addressed at the most senior level and rectified at the earliest opportunity Any new facilities or service should be designed with ease of appropriate cleaning in mind

•

3. Legal Framework

All members of the cleaning staff have a responsibility to conform and respect all aspects of the Health and Safety legislation; they also have a responsibility to make sure they follow instructions in accordance with either this manual or local policy, and not place themselves or others in danger. The Practice Manager has a key responsibility to ensure staff functions within the parameters of the legislation and have been trained and assessed accordingly. §

Health and Safety at Work Act 1974: Primary care is subjected to the same infection prevention and control regulations as other parts of the health services and General Practitioners (GPs) have a statutory duty under the Health and Safety at Work Act (1974) to

xxxxxx Issue Date: 00/00/0000 Review Date: 31/05/2016

create a safe environment. practices

This requires all employees to follow safe written working

Health and Safety Commission’s Legionnaires disease: the control of Legionella bacteria in water systems. Approved Code of Practice and guidance (2000) (also referred to as L8), it has a special legal status, and health and safety inspectors seek to secure compliance with the law and may refer to L8 as an illustration of good practice

§

Control of Substances Hazardous to Health Regulations 2002 (COSHH): the regulation’s aim is to reduce exposure to hazardous substances to acceptable levels, in order to minimise risks to staff and service users’ health. Employers have a duty to protect workers from hazards encountered during their work; this includes chemical and microbiological hazards, and also applies to the risk from exposure to legionella bacteria

§

Health and Social Care Act 2008 (2010): Criterion 2 of the Code of Practice levies on providers a specific duty to provide and maintain a clean and appropriate environment in managed premises that facilitates the prevention and control of infections

§

Personal Protective Equipment at Work Regulations 1992 (as amended): defines personal protective equipment as all equipment (PPE) including clothing which affording protection against the weather, which is intended to be worn or held by a person at work and which protects them against one or more risk to their health and safety

§

PPE Directive – 89/686/EEC Harmonisation of PPE laws: the European Union initiated the directive in order to ensure all products are equally safe throughout the European Union. The directive has been transposed into legislation. The directive details the basic safety requirements that a product must satisfy and the conditions for placing PPE on the market and for the free movement of goods within the EU including – routes to certification, EC type examination and CE marking. The directive divides all PPE into three different categories according to the degree of risk, the higher the risk the PPE protects against the more stringent the certification procedure: § Category 1: PPE protecting against minimal risks § Category 2: PPE protecting against normal risk, categorised as head, face, hearing, eye protectors, garments, shoes and gloves § Category 3: PPE intended to protect against mortal danger or against danger which may seriously or irreversibly damage health, or where the effects cannot be identified in sufficient time

§

PPE Directive - 89/656/EEC Use of PPE in the workplace: The Directive is concerned with the proper use of PPE and its role in improving standards of Health and Safety in the workplace. PPE should be considered when it is not possible to achieve the required degree of protection by any other method or as part of collective protection. The directive specifies: § That all PPE must comply with relevant EEC standards § All PPE provided must be suitable for the wearer and the task § If more than one item of PPE is to be used the items must be compatible § Where feasible PPE should be issued on a personal basis § All PPE must be used only for the purpose intended and in accordance with manufacturer’s instructions

xxxxxx Issue Date: 00/00/0000 Review Date: 31/05/2016

The Directive further places obligation on employers to: § Ensure all PPE in their workplace conforms to relevant EC standards § Conduct a risk assessment of the hazards § Define the characteristics of equipment necessary to protect employees § Keep records of assessments and reasons for selecting particular type of PPE Electrical equipment: the Health and Safety at Work Act 1974, Management of Health and Safety at Work Regulations 1999, Electricity at Work Regulations 1989, Workplace (Health, Safety and Welfare) Regulations 1992 and the Provision and use of Work equipment Regulations 1998; apply to all electrical equipment used in, or associated with, places of work. The scope extends from distribution system down to the smallest piece of electrical equipment. There is a requirement to inspect and test all types of electrical equipment in all work situations

4. Roles and Responsibilities

§

It is important to have clear cleaning responsibilities identified.

4.1 Registered Manager: are key to ensuring that this manual forms the basis of good practice in their area of responsibility and for leading and driving a culture of cleanliness in clinical areas, setting and monitoring standards in conjunction with others

4.2 Clinical staff: manager directly at service level, carry out cleaning duties primarily associated with service users or medical equipment, and the management of blood and/or body fluid spillages 4.3 Clerical staff: daily inspection of desk, ensure it is kept uncluttered to facilitate cleaning. To conduct periodic office inspections to ensure that the reception/office/waiting environment is maintained to a high standard 4.4 Domestic staff: day to day operational activity of cleanliness of the environment as detailed in their job description

4.5 Head of estates/Landlord: is responsible for the maintenance and repair of the building fabric with any associated cleaning requirements 4.6 Decontamination Lead: is ultimately responsible for the decontamination and infection prevention and control element, and is directly accountable to the Registered Manager. Is also responsible for ensuring that all validation, maintenance, testing and servicing documentation is in place 4.7 IPC Solutions: responsible for offering support, advice and guidance on specific and specialist cleaning requirements, training staff with regard to good hygiene standards and practice in relation to cleaning. 5. Risk management Cleaning requires the use of chemical agents, which may be potentially dangerous. Under COSHH employers are required to protect their staff and others who may be exposed to these chemicals. Each cleaning task should be risk assessed and specific precautionary measures should be incorporated into the method statement and incorporated into the technical training. COSHH sets out the following basic measures:

xxxxxx Issue Date: 00/00/0000 Review Date: 31/05/2016

§ § § § § § §

Asses the risks Decide what precautions are necessary Ensure that control measures are used and maintained Monitor the exposure Carry out appropriate health surveillance Prepare plans and procedures to deal with accidents, incidents and emergencies Ensure employees are properly informed, trained and supervised

• • • •

The maintenance and issue of up to date COSHH sheets relating to each of the chemical products used on the premises, including the actions to be taken in the event of an incident/accident Insistence of when to wear appropriate PPE for each task The labelling of chemical containers The storage of chemical products in a secure area, that is inaccessible to Service users Regular inspection of the use and storage of chemicals in use

•

The actions arising from the COSHH risk assessment will include:

5.1 Cleaning risk assessment: it is the Practice Managers responsibility to undertake a risk assessment of all activities, tasks and procedures carried out by the cleaning staff, and if necessary to take measures to eliminate or reduce the risk. A hazard is anything that may cause harm and a risk is the chance high or low, that the hazard could cause serious or minor harm to someone. It is recommended that a five step process should be followed: • • • • •

Identify the hazard Decide who might be harmed and how Evaluate the risk and decide on precautions Record the findings and implement them Review the assessment and update if required

5.2 Cleaning level assessment: the risk under consideration is the degree of infection risk which would be posed to service users, staff and visitors from inadequate cleaning, either in terms of frequency or efficacy; it should be based on the type of activity being conducted in the room. It is important to understand the level of risk involved; as the element of risk will be used to determine the frequency with which cleaning should take place. Once the function of the area has been identified an assessment of the degree of risk should be undertaken, it is recommended that this is based on three risk categories: •

•

High risk function areas: only consistently high cleaning standards will ensure the required outcome (i.e. treatment room, minor surgery room) Medium risk function areas: good standards of cleanliness are required for both hygiene and aesthetic reasons, they will not require the same level of intensity or frequency as high risk function areas (i.e. consulting room, waiting areas, dispensing areas, reception, kitchen, toilets) Low risk function areas: the risk posed to service users safety will be minimal, cleaning is more for aesthetic reasons and to provide reassurance to service users, staff and visitors (i.e. administrative, record storage, meeting rooms, corridors)

xxxxxx Issue Date: 00/00/0000 Review Date: 31/05/2016

5.3 COSHH assessment: COSHH regulations also apply to chemicals, and a COSHH assessment should be undertaken for every chemical used, this should be readily available. Staff should be aware of the use of the product, the implications for their storage, management of a spillage and the first aid requirements in the event of exposure to the chemical i.e. splash to the eye. The COSHH safety data sheets and product handling sheets must be provided by the respective company for all products used. The Practice Manager and/or Decontamination Lead should undertake the assessment, and a register of substances in use and their completed assessment sheets made available to staff in each functional area.

• • • •

5.4. Personal protective equipment: a risk assessment should be undertaken to determine which PPE is required for each cleaning task undertaken by staff. The assessment should incorporate the method statement and be incorporated into the technical and health and safety training. PPE should be supplied and used at work whenever there is a risk to the health and safety of staff which cannot be adequately controlled in any other way. All PPE used within the premises must bear the ‘CE’ mark, and they must be: Properly assessed before use to ensure that it is suitable Maintained and stored properly Provided with instructions on how to use it safely Used correctly by all staff

5.5 Electrical equipment: Check that all electrical equipment used for the purpose of cleaning is safe before use, is fit for purpose and has an up to date portable appliance test (PAT). It is vital that staff are able to report any defects to the Practice Manager immediately and the item should be labelled and removed from service.

5.6 Legionella risk assessment: the Practice Manager is the person responsible for managing the risk and needs to identify whether the water system is likely to create a risk of exposure to legionella. The risk assessment should include management responsibilities, description of the system, potential risk sources, any controls currently in place to control risks, monitoring, inspection and maintenance procedures, records of the monitoring results and inspection and checks carried out and a review date is included. If it is decided that the risks are insignificant and are being properly managed to comply with the law, the assessment is complete. The risk assessment should be reviewed periodically in case there are any changes in the system. 6. Clothing and jewellery

Loose fitting clothes and jewellery may become caught in machinery and should be avoided. Depending upon the nature of the task, a plain band ring may be worn. Advice should be sought from the Practice Manager if jewellery is to be worn for religious, health or other reasons before commencing work. Long hair should be tied up off the collar. 7. Safe manual handling

Training should be provided in the correct method of lifting, carrying, pushing and pulling. Any medical problem that could place an individual at risk when carrying out manual handling should be reported to the Practice Manager. If a member of staff is pregnant, a personal risk assessment should be carried out. 8. Health and Safety

xxxxxx Issue Date: 00/00/0000 Review Date: 31/05/2016

Effective health and safety management requires competency across every part of the organisation, competence is the ability for every member of staff to be able to recognise the risk in the cleaning activities, and then apply the right measures to control and manage these risks (HSE 2009).

8.1 General Health and Safety • Work in a controlled and systematic way, do not rush or become distracted • Use only authorised access and exit routes into buildings and functional areas • Always lift and move items in accordance with manual handling training • Keep work areas tidy, and tidy up as the work proceeds 8.2 Guidance related to cleaning activities Refer to the work schedule and identify the task to be performed Identify the type of area in which cleaning is to be performed and select the correct colour-coded equipment for the task, by reference to the national colour-coding system • Prepare cleaning solutions in strict accordance with the manufacturer’s instructions and training. If using spray-bottles, ensure that these are clearly labelled and are thoroughly cleaned before refilling • Do not mix chemicals and only use a cleaning product provided by your employer. • Plan the work and where necessary temporarily move any items that might obstruct to a new, safe location • Use hazard signs to warn other users of the area in which cleaning task is being conducted • After use, all equipment should be left clean, dry and tidy in a secure storage area, segregated according to colour-coding where appropriate • Refer to risk assessment to determine whether personal protective equipment should be worn, or other additional precautions are necessary • Follow the method statement and training when performing a cleaning task

• •

8.3 Personal safety Every member of staff should accept responsibility for their personal safety. Failure to comply with instructions, with written procedures, or with their training will increase the risk of causing an incident or accident which could harm them or others. Individual staff members should ensure that they: • Take reasonable precautions to safeguard the health, safety and welfare of themselves and others who may be affected by their work • Observe all health and safety rules and procedures • Use any health and safety equipment that is provided • Do not intentionally or recklessly interfere with or misuse anything that is provided in the interest of health and safety • Report any faulty equipment to the Practice Manager without delay • Alert their Practice Manger without delay if they notice a potential hazard • Do not attempt any task for which they have not received appropriate documented training

8.4 Using electrical equipment • Check equipment before and after use for damage or wear, which might potentially be dangerous, including breaks or cracks on the plug or cable • Check that there is a valid Portable Appliance Test (PAT) notice in place on any electrical equipment to be used • Any damaged or untested equipment should be reported immediately to the Practice Manager, who should ensure that the equipment is labelled as unfit for purpose and removed from use • When using electrical equipment, plan the work to ensure that the cable will always be behind the operator and the machine • Ensure that the switch is in the “off” position before plugging machinery into a wall socket

xxxxxx Issue Date: 00/00/0000 Review Date: 31/05/2016

• • •

Always unplug machinery before changing fittings or settings Ensure hands are dry when plugging or unplugging electrical machinery When plugging a machine into an electric socket, make sure the switch is in the off position Always make sure to plug the machine into a free plug socket The electrical cable must never be draped over the operatives shoulder or over the handle of the machine while the operative is working with the machine Do not adjust or change the fittings on the machine when it is plugged in Do not leave the machinery unattended where it could be a source of danger to others Should the machine switch off automatically, stop work and inform the Practice Manager

• • • • •

9. Record keeping

10. Training

Records should be maintained in accordance with the Code of Practice (DH 2013). It is often during cleaning work that minor defects, wear or damage will be detected. Local policies should ensure that such defects are reported to the responsible person as soon as it is practicable.

All staff with cleaning as their core work activity should receive induction and continuous training and should complete this training before they are allowed to work without direct supervision. Training should include as a minimum: • • • • •

•

Infection Prevention and Control Cleaning Methods Use of equipment, and colour coding use of chemicals, health and safety, manual handling Other identified specific training requirements may include new technology, specialist cleaning, personal development or poor performance Other training includes manual handling, fire, health and safety and site orientation

There should be a nominated individual who has responsibility for monitoring training, and up to date training records that are signed and dated should be maintained in accordance with the Code of Practice (DH 2013). 10.1 Technical training

Cleaning staff should have current documented training in the performance of cleaning tasks and the use of equipment. Training typically consists of four elements; instruction, demonstration, question and repeated observation of performance. These should be repeated until satisfactory performance is consistently achieved. The training should be consistent with the cleaning method statements within this manual. Training in performance of tasks will include the correct use of cleaning products and materials and training should be consistent with the manufacturer’s instructions. When there is a change in cleaning products, materials or equipment, staff should receive appropriate training prior to using the new products, materials or equipment.

xxxxxx Issue Date: 00/00/0000 Review Date: 31/05/2016

Section 3: Infection Prevention and Control The acquisition and/or transmission of infection can be described as the ‘chain of infection’. This can be described as a chain that has several links which are linked together to form a circle, this circle can only be broken when a link is removed.

Causative Agent

Susceptible Host

Reservoir

Portal of Exit

Portal of Entry

1. Chain of infection

Transmissio n

Causative Agent: Any microorganism that can cause a disease such as a bacteria, virus, parasite, or fungus

•

Reservoirs: these are places where the microorganisms may live and survive. These can include people, animals, equipment, environment, food and water

•

Portal of exit: The place where the organism leaves the reservoir, such as the respiratory tract, intestinal tract urinary tract, or blood and other body fluids

•

Transmission: The means by which an organism transfers from person to person which can be either direct transmission (direct contact between infectious host and susceptible host) or indirect transmission (which involves an intermediate carrier like hands of healthcare worker, an environmental surface or piece of medical equipment)

•

Portal of entry: The opening where an infectious disease enters the host’s body such as mucus membranes, open wounds, inoculation injury, or tubes inserted in body cavities like urinary catheters or feeding tubes.

•

Susceptible host: The individual who is at risk of developing an infection from contact with the disease. Several factors make a person more susceptible to infections including age (young and elderly generally more at risk), underlying chronic diseases such as diabetes or asthma, conditions that weaken the immune system like HIV, certain types of medications, invasive devices like feeding tubes and catheters.

•

xxxxxx Issue Date: 00/00/0000 Review Date: 31/05/2016