Download Community Infection Prevention and Control Guidelines

- CLINICAL-CLINICAL- CLINICAL- CLINICAL- CLINICAL- CLINICAL- CLINICAL- CLINICAL- CLINICAL- CLINICAL- CLINICAL-CLINICAL- CLINICAL
Community Infection
Prevention and Control
Guidelines
CLINICAL POLICY – ACE 153
Version number:
6.1
Policy Owner:
Head of Infection Prevention and Control
Lead Director:
Managing Director
Date Approved:
December 2012
Approved By:
Quality & Safety Assurance Group
Review Date:
December 2014
Target Audience:
All Staff
ACE INFECTION PREVENTION AND CONTROL TEAM
COMMUNITY INFECTION CONTROL GUIDELINES
CONTENTS
Page
Section Topic
ACE Community Infection Prevention and Control Guidelines
Introduction
Purpose
Scope
Equality Impact Assessment
Duties within the organisation
Guideline Development
Dissemination and Implementation Process including Training
Library and Archiving arrangements
Monitoring and Evaluation
Associated Documents and Policies
Contacts
1
2
Infection, its causes and spread
1. The Causes of infection
2. The Spread of infection
3. The Chain of Infection
9
9
10
Standard Precautions
1. Introduction
2. Hand hygiene and skin care - This section has been updated.
Please now refer to the Hand Hygiene Policy and Procedure ACE273
3.
4.
5.
3
5
5
5
5
6
6
6
6
7
7
8
Protective clothing
Safe handling of sharps
Spillage Management
Surveillance & Notification Procedures for Infectious Diseases
including OUTBREAKS - This section has been updated.
12
13
13
15
18
21
Please now refer to the Guidelines for the Control of Outbreaks of
infection including surveillance and notification procedures for infectious
diseases ACE314
4
Sharps & Body Fluid Contamination Injuries
1. General Infection Control Measures
2. Occupational sharps or splash injuries acquired by ACE staff
For full guidance including the procedure in the event of a sharp
injury/contamination incidents, all staff should refer to The Needle stick and
Contamination Injuries Procedure clinical policy ACE45
Owner: Infection Prevention and Control Team
Version 6.1
Page 2 of 104
Review: December 2014
22
22
5
6
Staff Health
1. Introduction
2. Staff Health
3. Staff who perform EPPs
4. Staff with potential infectious diarrhoea or any other infectious
diseases
5. Staff potentially exposed to Blood Borne Virus
6. Health Clearance for TB, Hepatitis B & C and HIV: New Health
Care workers; DH March 2007
7. Occupational Health for Other Employers
23
23
25
25
26
26
27
Management of Infectious Diseases
Also refer to the Guidelines for the Control of outbreaks and infection including
surveillance and notification Clinical Policy ACE314 and Section 7.3 of these
Guidelines.
1.
2.
3.
4.
5.
6.
7.
8.
9.
7
Fact Sheets
Table of common infectious diseases
Guidelines for management of MRSA in the Community
Extended Spectrum Beta Lactomase (ESBL) producers
Preventions and control of Headlice in the Community
Preventions and control of Scabies in the Community
Transmissible Spongiform Encephalopathies, New Variant
Creutzfeldt – Jacob Disease (CJD)
New Entrants to the UK and Infectious Diseases
Pregnancy and Infectious Diseases
Clinical Practice
1. Information on Antibiotic Prescribing Formularies in North East
Essex
2. Aseptic Non Touch Technique – Please also refer to the Aseptic Non
3.
4.
5.
6.
7.
8.
9.
10.
11.
12.
13.
14.
Touch Technique Clinical Policy ACE368 - Principles of best practice for
clinical procedures
Barrier nursing (isolation of patients) – Please also refer to Guidelines
for the Control of outbreaks and infection including surveillance and notification
Clinical Policy ACE314 and Section 6 of these guidelines
Decontamination of Equipment including disinfectant – Please also
refer to the Decontamination Policy and Procedure Clinical Policy ACE673 and
Medical Devices Policy Clinical Policy ACE183.
Environmental Cleaning (including Legionella control) – Please also
refer to the Decontamination Policy Clinical Policy ACE367 or Legionella
Policy Clinical Policy ACE296
Enteral Feeding and Infection Prevention and Control
Intravenous Therapy and Infection Prevention and Control
Urinary Catheters and Infection Prevention and Control
Management of non infectious deceased clients
Minor Surgical procedures undertaken by ACE staff
Laundry Management (including staff and patient clothing)
Safe Handling of Specimens
Vaccine Control and mass vaccination sessions
Waste Management – Please also refer to the Clinical Waste Policy
ACE295
Owner: Infection Prevention and Control Team
Version 6.1
Page 3 of 104
Review: December 2014
29
29
39
39
42
48
52
55
55
57
57
57
62
63
67
69
77
80
83
89
92
94
97
8
9
Vaccinations
1. Advice on Childhood Immunisations
2. Advice on Travel vaccinations
98
98
Appendices
Appendix 1 –
Appendix 2 –
99
99
Care bundle for preventing the spread of infection
Care bundle for Peripheral Intravenous (IV) Cannula:
Insertion actions
Appendix 3 – Care bundle for Peripheral Intravenous (IV) Cannula:
Ongoing care
Appendix 4 – Care bundle for Urinary Catheter Care: Insertion
Appendix 5 – Care bundle for Urinary Catheter Care: Continuing care
Appendix 6 – Care bundle for Central Venous Catheters: Ongoing
care
Appendix 7 – Care bundle for Enteral Feeding
Appendix 8 – Essential Steps compliance and reporting framework
Appendix 9 – Essential Steps – feedback form
Appendix 10 – Inter-Healthcare Patient Infection Prevention and
Control Transfer Form
10
References
99
99
99
99
99
100
101
102
103
Owner: Infection Prevention and Control Team
Version 6.1
Page 4 of 104
Review: December 2014
ACE COMMUNITY INFECTION PREVENTION AND CONTROL
GUIDELINES
Introduction
These guidelines must be read in conjunction with the over-arching ACE Infection
Prevention and Control Policy (which refers to all National legislation and guidance
including the duties of the Health and Social Care Act 2008: Code of Practice for on
the prevention and control of infections and related guidance.
Infection control is an important part of an effective risk management programme to
improve the quality of patient care and the occupational health of staff.
The organisation has a legal obligation to take appropriate steps to protect patients,
staff and visitors from harm.
Purpose
The purpose of this manual is to assist the Anglian Community Enterprise (ACE) in
meeting their legal obligations in regard to the prevention and control of infections
and to ensure that every member of staff is aware of their individual responsibility in
relation to the prevention and control of infection.
Scope
The document includes guidance on care provided in Community Hospitals, clients
own homes, clinics, day care facilities, GP Practices covering all areas of health care
provision as provided by ACE.
It is acknowledged that some users of these guidelines work in premises over which
they have little or no control (e.g. client’s own homes). Therefore in some instances
users will have to use their own judgement in the interpretation of the guidelines.
Further advice is available from the ACE Infection Prevention and Control Team
(IPCT).
Please be aware that the ACE IPCT is NOT responsible for care homes or services
provided by agencies outside the Organisation.
N.B. For advice or to report an outbreak of infection in a care home, calls should be
directed to the Essex Health Protection Unit (0845 1550069).
Equality Impact Assessment
This document has been assessed for equality impact. The policy is applicable to
every member of staff within ACE irrespective of their race, ethnic origin, nationality,
gender, culture, religion or belief, sexual orientation, age or disability.
Owner: Infection Prevention and Control Team
Version 6.1
Page 5 of 104
Review: December 2014
Duties within the organisation
All staff are expected to understand the importance of infection prevention and control
precautions and procedures, particularly the value of hand hygiene. All staff have an
implicit responsibility to ensure they abide by these guidelines and the associated Infection
Prevention and Control Policy and Assurance Framework ACE 265 (For further
information on individual roles and responsibilities please see section 5.2 in ACE 265).
The philosophy of this set of guidelines is to encourage individual responsibility by every
member of staff. All staff should participate in the prevention and control of infection
ensuring that there are effective arrangements in place and to take the necessary actions
to prevent the spread of infections.
Where reference is made to follow the manufacturers’ guidance, it is the responsibility of
the user to ensure that they have sourced the guidance from the manufacturer
themselves.
Guideline Development
Consultation and communication with stakeholders during development
The guidelines has been consulted on and communicated to the External Consulting
Team and the Governance and Risk Committee.
Approval and ratification process
The guidelines is approved and ratified by the Clinical Effectiveness Group and Integrated
Governance and Risk Committee.
Owner and version control/review processes
Guideline is reviewed constantly to reflect any Department of Health changes or local
developments, however if no updates or developments received policy is reviewed
annually. This is currently version 5.
Dissemination and Implementation Process including Training
These guidelines are available on the ACE Extranet and will be disseminated via team
meetings through the Cascade 7 Shape Our Future bulletin. They must be read in
conjunction with Infection Control Policy ACE265 and other associated documents and
policies as set out in Section 10 (available via the extranet).
Training and education on Infection Prevention and Control is provided by the IPCT and
mandatory annually for all clinical staff as referenced within the training directory available
via the extranet.
Library and archiving arrangements
Once an out of date policy has been removed from the extranet, the policy will be stored in
an electronic archive file. This will be maintained by the Healthcare Quality teams
Owner: Infection Prevention and Control Team
Version 6.1
Page 6 of 104
Review: December 2014
Monitoring and Evaluation
Monitoring of compliance with these guidelines will be undertaken through the following
audits.
Weekly Hand hygiene audits within community hospitals
Annual environmental audits: Community clinics, community hospital wards and
departments
MRSA pathway audit
Essential Steps care bundles audits undertaken monthly for key clinical interventions
all provider services as appropriate to service:
-
Observational audit ‘preventing the spread of infection’. hand hygiene, personal
protective equipment, sharps and aseptic / non touch technique.
Catheter insertion and ongoing care
Enteral feeding care
Central venous access devices
Peripheral intravenous cannula insertion and ongoing care.
See appendix’s 1 - 7 for essential steps checklists, feedback form and compliance
standard, actions and reporting framework
These are registered with the Infection Prevention and Control Clinical Audit Programme
2011 and reported to the ACE Infection Control Committee. The results inform training
needs and support development of practice. In addition information from clinical incident
reporting will inform action planning.
Other associated audits and monitoring
Intravenous therapy annual audit coordinated by the respective Head of Service in
conjunction with & ward /dept / team managers (Community Hospitals / Community)
For details see Clinical Policy ACE275
Urinary catheter annual audit undertaken by the Continence and Urology team. For
details see Clinical Policy ACE52
Aseptic non touch technique annual audit undertaken by the Clinical Development
Team. For details see Clinical Policy ACE368
MRSA screening within 24 hours of admission (community hospitals). Live register
maintained by community hospitals. For details see Clinical Policy ACE277
Associated documents and policies
Hand Hygiene Policy and Procedure (Clinical Policy ACE273)
Infection Prevention and Control Policy and Assurance Framework (Clinical Policy
ACE265)
Guidelines for the control of Outbreaks of Infection including surveillance and
notification procedures for infectious diseases (Clinical Policy ACE314)
Methicillin–Resistant Staphylococcus aureus (MRSA) Policy and Procedure
(Clinical Policy ACE277)
Policy for Peripheral Vascular Devices and Intravenous Therapy (Adult) (Clinical
Policy ACE275)
Owner: Infection Prevention and Control Team
Version 6.1
Page 7 of 104
Review: December 2014
Aseptic Non Touch Technique. Principles of best practice for clinical procedures
(Clinical Policy ACE368)
Needlestick and Contamination Injuries Procedure (Clinical Policy ACE45)
Patient latex allergy and sensitisation – Guidance for Staff (Clinical Policy ACE502)
Dress Code for Staff/Uniform Policy, Operational policy for clinical staff
uniform/non-uniform and guidance for other staff (Clinical Policy ACE5)
Policy and procedure for the prevention and management of clostridium difficile
associated disease (CDAD) in the community hospitals (Clinical Policy ACE84)
Decontamination Policy and Procedure (Clinical Policy ACE367)
Skin Cleansing Protocol (Clinical Policy ACE 260)
Clinical Waste Policy (Non-Clinical Policy ACE295)
Contacts
ACE Infection Prevention and Control Team
Infection Control advice can be obtained from the Infection Prevention and Control
Nursing Team.
Tel: 01255 206244 / 01255 206248
Mobile: 07786334419 / 07884490521
Out of hours
Any URGENT enquiries, particularly to report an outbreak of infection within ACE
premises – contact the on-call senior manager and the on call Public Health person 01245
444417 and ask for the “on- call public health person”.
Please ensure the Infection Prevention and Control Team is informed of any out-of hours
calls, on the next working day.
Other useful Numbers and contacts
Medical Microbiologist Colchester General Hospital
01206 747474
Essex Health Protection Unit
0845 1550069
Occupational Health Team
01206 851436
Health Protection Agency (List of Infectious Diseases)
http://www.hpa.org.uk/Topics/InfectiousDiseases/InfectionsAZ/
Saving Lives
http://www.clean-safe-care.nhs.uk/index.php?pid=2
Owner: Infection Prevention and Control Team
Version 6.1
Page 8 of 104
Review: December 2014
SECTION 1 – INFECTION, ITS CAUSES AND SPREAD
The purpose of this section is to ensure that every member of staff understands the
causes and spread of infection.
1.1.
The causes of Infection
Micro organisms that cause infections are known as pathogens. They may be classified
as follows:
Bacteria are minute organisms about one-thousandth to five-thousandths of a millimetre
in diameter. They are susceptible to a greater or lesser extent to antibiotics.
Viruses are much smaller than bacteria and although they may survive outside the body
for a time they can only grow inside cells of the body. Viruses are not susceptible to
antibiotics, but there are a few anti-viral drugs available which are active against a limited
number of viruses.
Pathogenic Fungi can be either moulds or yeasts. For example, a mould, which causes
infections in humans, is Trichophtyon rubrum, which is one cause of ringworm, and which
can also infect nails. A common yeast infection is thrush caused by Candida albicans.
Protozoa are microscopic organisms, but larger than bacteria. Free-living and nonpathogenic protozoa include amoebae and paramecium. Examples of medical importance
include: Giardia lamblia, which causes an enteritis (symptoms of diarrhoea).
Worms are not always microscopic in size but pathogenic worms do cause infection and
some can spread from person to person. Examples include: threadworm and tapeworm.
Prions are infectious protein particles.
Creutzfeldt-Jacob Disease.
1.2.
Example: the prion causing New Variant
The Spread of Infection
One feature that distinguishes infection from all other disease is that it can be spread, i.e.
one person can ‘catch’ it from another or via a vector (e.g. crawling or flying insects).
It is convenient to classify the modes of spread of infection as follows:
Direct Contact. Direct spread of infection occurs when one person infects the next by
direct person-to-person contact (e.g. chicken pox, scabies, sexually transmitted infections
etc.).
Indirect. Indirect spread of infection is said to occur when an intermediate carrier is
involved in the spread of pathogens e.g. fomite or vector.
A fomite is defined as an object, which becomes contaminated with infected
organisms and which subsequently transmits those organisms to another person.
Owner: Infection Prevention and Control Team
Version 6.1
Page 9 of 104
Review: December 2014
Examples of potential fomites are bedpans, urinals, oxygen masks or practically
any inanimate article.
Crawling and flying insects are obvious examples of vectors and need to be
controlled. Insect bites may cause infections such as malaria.
Hands. The hands of health and social care workers are probably the most important
vehicles of cross-infection. The hands of patients can also carry microbes to other body
sites, equipment and staff.
Inhalation. Inhalation spread occurs when pathogens exhaled or discharged into the
atmosphere by an infected person are inhaled by and infect another person. The common
cold and influenza are often cited as examples, but it is likely that hands and fomites
(inanimate objects) are also important in the spread of respiratory viruses.
Ingestion. Infection can occur when organisms capable of infecting the gastro-intestinal
tract are ingested. When an infected person excretes these organisms faecally, faecaloral spread is said to occur. Organisms may be carried on fomites, hands or in food and
drink e.g. Hepatitis A, salmonella, campylobacter.
Inoculation. Inoculation infection can occur following a “sharps” injury when blood
contaminated with, for example, Hepatitis B virus, is directly inoculated into the blood
stream of the victim, thereby causing an infection. Bites from humans can also spread
infection by the inoculation mode.
1.3. The Chain of Infection
Understanding how infection is transmitted enables the development of strategies to
support infection prevention and control. This is commonly known as the Chain of Infection
(Storr and Clayton-Kent 2004). By considering the chain of infection i.e. the source of
infection, mode of spread, person at risk and potential portals of entry, it is possible to
implement measures to break the chain and prevent the spread of infection.
The Source, describes the environment in which a micro-organism can survive e.g.
places, people and on equipment
Mode of Spread, as detailed above e.g. direct or indirect contact, droplet
transmission/inhalation, ingestion and inoculation and in some instances from mother to
foetus via the placenta.
This is the easiest link in the chain to break and is therefore the key to cross infection
control
Person at Risk, certain groups of people are at increased risk of acquiring infections e.g.
the old, very young, those who are immuno-compromised or on immunosuppressive
treatment and those whose normal body defence mechanisms are compromised e.g. by
the insertion of catheters, peripheral cannulae, feeding tubes, wounds etc.
Portal of Entry, describes the way the infection enters the body e.g. by all the
transmission methods described above and in particular in health care, from any
procedure which breaches the bodies defences, i.e. wound dressings, insertion of
catheters and lines, surgery etc.
Owner: Infection Prevention and Control Team
Version 6.1
Page 10 of 104
Review: December 2014
The strict application of standard precautions is the unified approach for the
implementation of measures to prevent the transmission of infection from all persons as
everybody should be treated in the same way regardless of their known, unknown or
suspected infectious status.
Mode
of
Spread
Source
The Chain of Infection
Portal
of
Entry
Person
at
Risk
By breaking the chain of infection, transmission of infection can be prevented
Owner: Infection Prevention and Control Team
Version 6.1
Page 11 of 104
Review: December 2014
SECTION 2 – STANDARD PRECAUTIONS
The purpose of this section is to ensure that every staff member understands the
importance of and their responsibility for using Standard precautions as a matter of good
practice.
2.1.
Introduction
It is not always possible to identify people who may spread infection to others, therefore
precautions to prevent the spread of infection must be followed at all times. These routine
procedures are called standard precautions, previously known as universal
precautions.
Standard Precautions include:
Hand washing and skin care - This section has been updated. Please refer to the Hand Hygiene
Policy and Procedure ACE273
Protective clothing
Safe handling of sharps (including sharps injury management)
Spillage management
All blood and body fluids are potentially infectious and precautions are necessary to
prevent exposure to them. As well as protecting Healthcare Workers from infection,
standard precautions also make a contribution to the reduction of HCAIs.
A disposable apron and disposable gloves should always be worn when dealing
with excreta, blood and body fluids.
Everyone involved in providing health and social care in the community should know and
apply the standard principles of hand decontamination, the use of protective clothing, the
safe disposal of sharps and body fluid spillage management. Each member of staff is
accountable for his/her actions and must follow safe practices
Owner: Infection Prevention and Control Team
Version 6.1
Page 12 of 104
Review: December 2014
2.2.
Hand Hygiene and Skin Care
Please refer to the “Hand Hygiene Policy and Procedure”, Clinical Policy ACE273.
Hand Hygiene is recognised as the single most effective method of controlling
infection.
2.3
Protective Clothing
Selection of protective equipment must be based on an assessment of the risk of
transmission of micro-organisms to the patient from the healthcare practitioner and the risk
of the healthcare practitioner’s clothing and skin being contaminated by the patient’s
blood, body fluids, secretions or excretions.
Assessment of Risk
WHAT TO WEAR WHEN
No exposure to
blood/ body fluids
anticipated
No protective
clothing
Exposure to blood/body
fluids anticipated, but low
risk of splashing
Exposure to blood/body
fluids anticipated - high
risk of splashing to face
Wear gloves and a plastic
apron
Wear gloves, plastic
apron and
eye/mouth/nose
protection
Types of Protective Clothing
Disposable Gloves
It is important to make a risk assessment of the procedure to be performed to decide
whether gloves should be worn and which type of glove is required (e.g. sterile, nonsterile, type of material - vinyl/nitrile.
The organisation is committed to following best practice in reducing the use of latex
gloves and all latex products to an absolute minimum to reduce the health risk posed
by natural rubber latex to staff and patients
For further details on glove selection and latex sensitivity please refer to:
Patient latex allergy and sensitisation – Guidance for staff (Clinical Policy ACE
502)
Aseptic Non -Touch Technique Policy (Clinical policy ACE368)
Gloves must be worn for invasive procedures, contact with sterile sites and non-intact skin
or mucous membranes, and all activities that have been assessed as carrying a risk of
exposure to blood, body fluids, secretions or excretions, or to sharp or contaminated
instruments.
Owner: Infection Prevention and Control Team
Version 6.1
Page 13 of 104
Review: December 2014
Gloves that are acceptable to healthcare personnel and that conform to European
Community (CE) standards must be available.
Gloves must be worn as single-use items. They must be put on immediately before an
episode of patient contact or treatment and removed as soon as the activity is completed.
Gloves must be changed between caring for different patients, and between different care
or treatment activities for the same patient, and are not a substitute for hand washing.
Gloves must be disposed of appropriately according to the organisations clinical waste
policy and hands decontaminated after the gloves have been removed.
Gloves should not be washed between patients as the gloves may be damaged by the
soap solution and, if punctured unknowingly, may cause body fluid to remain in direct
contact with skin for prolonged periods
o Non Sterile Gloves
Should be used when hands may come into contact with body fluids or equipment
contaminated with body fluids.
o Sterile Gloves
Should be used when the hand is likely to come into contact with key parts ie normally
sterile areas or during any surgical procedure. Key parts are the aseptic parts of the
procedure / equipment that need to have direct contact with aseptic key-parts of the
patient, key sites or any liquid infusion. If contaminated, key parts provide a direct route
for transmission of pathogens between the procedure and the patient. For further
details please refer to the Aseptic Non -Touch Technique Policy NE368
o General Purpose Utility Gloves
General-purpose utility gloves e.g. rubber household gloves, can be used when
coming into contact with possibly contaminated surfaces or items. Ideally, colour
coding of such gloves should be used e.g. Green for the kitchen, catering departments
and patient food service areas, blue for general areas, wards, offices and basins in
public areas, Red for ‘bathrooms, washrooms, showers, toilets, basins and bathroom
floors, yellow for isolation however these would require disposal after each use so that
there is no risk of the same gloves being used in other isolation rooms, alternatively
disposable gloves can be used.
Adapted from NPSA National Colour Coding Scheme (Jan 2007)
This will help prevent cross-infection from one area of work to another. The rubber
household gloves should be washed with general-purpose detergent and hot water,
and dried between use. They should be discarded weekly or more frequently if the
gloves become damaged.
Disposable Plastic Aprons
Should be worn when there is a risk that clothing may be exposed to blood, body fluids,
secretions or excretions, with the exception of sweat.
Owner: Infection Prevention and Control Team
Version 6.1
Page 14 of 104
Review: December 2014
Plastic aprons should be worn as single-use items, for one procedure or episode of patient
care, and then discarded and disposed of as clinical waste.
Plastic aprons should be colour-coded to ensure staff are changing aprons between
patients and to prevent cross-infection.
Recommended disposable apron colours:
White for all direct patient care
Yellow (or red if not available) for isolation/barrier nursing
Green for food service
Face Masks and Eye Protection
Must be worn for protection where there is a risk of blood, body fluids, secretions or
excretions splashing into the face and eyes. Surgical facemasks with visors or goggles or
full-face visors are all available for use as required.
Respiratory Protective Equipment
Generally not required in ACE settings. Occasions when they may be required would be a
particulate filter mask, which must be used when clinically indicated for the care of patients
with respiratory infections transmitted by airborne particles e.g. MDR pulmonary
tuberculosis. (FFP3 disposable respirator masks must be correctly fitted and used (fit
testing required).
Footwear
Feet should always be enclosed in appropriate footwear. Please see the Dress code for
staff/uniform policy (Clinical Policy ACE5)
2.4
Safe Handling of Sharps
For occupationally acquired sharps injuries refer and follow Needlestick and
Contamination Injuries Procedure CLINICAL POLICY – ACE45
All staff should be fully immunised according to national policy. In addition, all those
handling sharps should have had a course of hepatitis B vaccine. A record of hepatitis B
antibody response should be kept for all clinical staff involved in ‘exposure prone
procedures’ or where regular exposure to blood/blood stained body fluids occurs. Please
see section 5.2 regarding Immunisations recommended for Health Care Workers (HCWs)
Care should be taken to avoid accidental needle stick injury, as exposure to contaminated
blood, may be associated with transmission of blood borne viruses.
Sharps include needles, scalpels, stitch cutters, glass ampoules, sharp instruments and
broken crockery and glass. Sharps must be handled and disposed of safely to reduce the
risk of exposure to blood borne viruses. Always take extreme care when using and
disposing of sharps. Avoid using sharps whenever possible.
There should be enough portable sharp bins for staff at all times, to allow the used needle
to be disposed of safely at the point of use. This should also reduce the number of
Owner: Infection Prevention and Control Team
Version 6.1
Page 15 of 104
Review: December 2014
incidents resulting from needles being left in bedding etc. The sharps bins should be
puncture resistant, of adequate depth and capacity and conform to British Standard 7320.
A risk assessment should be carried out in all areas where staff may be exposed to blood
or other potentially infectious materials. Where possible, technologies to reduce exposure
should be considered e.g. needlesafe or needlefree devices
Gloves should be worn for all procedures involving blood or body fluids, this includes
venepuncture. The glove will have the effect of wiping off the excess blood before it
penetrates the skin.
Clinical sharps should be single use only
Sharps must not be passed directly from hand to hand and handling should be kept to
a minimum
Do not re-sheath a used needle. Needles and syringes, should be disposed of as a
complete unit, they should not be disassembled.
Needles must not be bent, broken or disassembled before use or disposal
Discard sharps directly into a sharps container immediately after use and at the point
of use
Sharps containers should be available at each location where sharps are used
Sharps containers must comply with UN 3921 and BS7320 standards
Care must be taken when assembling sharps containers to ensure the lid is securely in
place. Sharps containers must be sealed, labelled and replaced when three quarters
full. If the sharps container is seldom used, it should be replaced after a maximum of 3
months regardless of the filled capacity. Therefore the sharps container must be
signed and dated on assembly in order to identify when 3 months have expired.
Ensure the temporary closure mechanism is in place when the sharps container is not
in use or when carrying
Place sharps containers on a level stable surface
Do not place sharps containers on the floor, window sills or above shoulder height use wall or trolley brackets
Assemble sharps containers by following the manufacturer’s instructions
Carry sharps containers by the handle - do not hold them close to the body
Never leave sharps lying around or for others to clear up
Open footwear should not be worn in situations where blood might be spilt or sharp
instruments are being used.
Do not try to retrieve items from a sharps container
Owner: Infection Prevention and Control Team
Version 6.1
Page 16 of 104
Review: December 2014
Do not try to press sharps down to make more room
Lock the container when it is filled to the fill line using the closure mechanism
Label sharps containers with the source details prior to disposal
Place damaged sharps containers inside a larger container - lock and label prior to
disposal. Do not place inside yellow clinical waste bag.
Face-shields or protective eyewear should be worn if appropriate
Blood spillages should be cleared up promptly.
Diabetic Sharps
All diabetic sharps should be placed into a sharps container (this includes lancets).
General Practitioners can prescribe sharp boxes on FPIO. General Practitioners should
ensure that the patient is aware of the correct method for disposal of the filled sharps bin.
Alternative approaches may include: returning it to the General Practice Pharmacy or
returning it to a local clinic.
Giving Injections
Always wash hands thoroughly prior to giving an injection.
If visibly dirty, skin should be cleaned with an individually packed single use swab soaked
in 70% isopropyl alcohol and left to dry. If the skin is not dry before proceeding, skin
cleaning is ineffective and the antiseptic may cause irritation by being injected into the
tissues (Dougherty and Lister 2008)
If skin is clean, this step may not be necessary.
For further information on skin cleansing please see the Skin cleansing protocol ACE 260.
Training
Independent studies show that a combination of training, safer working practices and the
use of medical devices incorporating sharps protection mechanisms can prevent more
than 80% of needle stick injuries.
In all training programmes specific time must be given to:
The risks associated with blood and body fluid exposures
The correct use and disposal of sharps
The use of medical devices incorporating sharps protection mechanisms
Management of sharps and body fluid contamination injuries
Owner: Infection Prevention and Control Team
Version 6.1
Page 17 of 104
Review: December 2014
2.5.
Spillage Management
Deal with blood and body fluid spills quickly and effectively. All staff should know who is
responsible for spillage management in their work area. In clinical areas this would
normally be the nursing staff. Domestic cleaning may also be required after the body fluid
spillage has been dealt with.
For staff working in health care premises (e.g. clinics, general practices, in-patient
units), ideally a ‘grab bucket’ containing all the relevant equipment should be readily
available to deal with a spillage of body fluids.
The kit should be kept in a designated place (depending on the size of the establishment
there may be more than one kit.
The kit should comprise:
‘nappy’ type bucket with a lid
non-sterile vinyl gloves and nitrile gloves for contact with blood
disposable plastic apron
disposable face protection
disposable paper towels
disposable cloths
clinical waste bag
small container of general purpose detergent
sodium dichloroisocyanurate compound NaDCC (e.g. Actichlor, Sanichlor, HazTabs) or hypochlorite solution (e.g. Household bleach or Milton) – to comply with
COSHH Regulations 2002 (please also refer to the COSHH policy ACE161) –
these compounds should be kept in a lockable cupboard
absorbent powder e.g. vernagel to soak up the liquid content of the spillage.
The kit should be immediately replenished after use.
Commercially produced spillage kits are available from stores e.g. Biohazard Spill Kit
For spillage of high-risk body fluids such as blood, method A is recommended.
For spillage of low-risk body fluids (non-blood containing excreta) such as excreta, vomit
etc use method B.
For staff working in the clients’ own home the following guidance should be adhered to
as closely as possible:
A. For spillage of high risk body fluids such as blood - Hypochlorite / Sodium
Dichloroisocyanurates (NaDCC) method
Prevent access to the area containing the spillage until it has been safely dealt
with
open the windows to ventilate the room if possible
wear protective clothing including face protection if required
Owner: Infection Prevention and Control Team
Version 6.1
Page 18 of 104
Review: December 2014
soak up excess fluid using disposable paper towels and/or absorbent powder
e.g. vernagel
cover area with NaDCC granules (e.g. Actichlor, Sanichlor, Haz-Tabs
according to manufacturers guidance) 10,000 parts per million available
chlorine
OR
cover area with towels soaked in 10,000 parts per million of available
chlorine(av cl) (1% hypochlorite solution = 1 part household bleach to 10 parts
water) e.g. household bleach, Milton, and leave for at least two minutes
remove organic matter using the towels and discard as clinical waste
clean area with detergent and hot water, and dry thoroughly
clean the bucket/ bowl in fresh soapy water and dry
discard protective clothing as clinical waste
wash hands.
NB Chlorine fumes will be released when chlorine-releasing substances are used so
ensure area is well ventilated.
DANGER- do not put chlorine-releasing substances including granules on urine spills. If
blood is visible in the urine, mop up the urine spill first and clean with detergent, then wipe
over the area with a 10,000 ppm av cl solution.
Contact domestic staff to spot clean the area with detergent after spillage has been dealt
with after using method A.
B. For spillage of low risk body fluids (non-blood containing excreta) - Detergent
and water Method
Prevent access to the area until spillage has been safely dealt with
wear protective clothing
mop up organic matter with paper towels or disposable cloths and/or
absorbent powder e.g. vernagel
clean surface thoroughly using a solution of detergent and hot water and
paper towels or disposable cloths
rinse the surface and dry thoroughly
dispose of materials as clinical waste
clean the bucket/ bowl in fresh hot, soapy water and dry
discard protective clothing as clinical waste
wash hands.
N.B. – For spills on carpets and upholstery with or without visible blood
wear protective clothing
Owner: Infection Prevention and Control Team
Version 6.1
Page 19 of 104
Review: December 2014
mop up organic matter with paper towels or disposable cloths and/or absorbent
powder e.g. vernagel
clean area with cold water
clean area thoroughly with detergent and hot water
allow to dry
discard protective clothing
wash hands
ideally, once dry, go over area with a mechanical cleaner or steam clean.
Owner: Infection Prevention and Control Team
Version 6.1
Page 20 of 104
Review: December 2014
SECTION 3 – SURVEILLANCE & NOTIFICATION PROCEDURES FOR INFECTIOUS
DISEASES INCLUDING OUTBREAKS
Please refer to the “Guidelines for the control of outbreaks of infection including
surveillance and notification procedures for infectious diseases”, Clinical Policy
ACE314
Owner: Infection Prevention and Control Team
Version 6.1
Page 21 of 104
Review: December 2014
SECTION 4 –SHARPS AND BODY FLUID CONTAMINATION INJURIES
Every member of staff must understand their individual responsibility for the prompt
treatment of sharps and body fluid contamination injury
This section provides general infection prevention and control measures but for full
guidance including the procedure in the event of a sharp injury/contamination incident,
all staff should refer to The Needlestick and Contamination Injuries Procedure
Clinical policy – ACE45
4.1.
General infection control measures
A. Standard Precautions
All staff must understand and implement all routine infection control procedures, including
the use of Standard Precautions i.e. use of protective clothing, safe handling of sharps etc,
at all times. These Standard Precautions are designed to prevent transmission of infection
including bloodborne viruses.
B. Health care worker immunisation
Please refer to section 5.2 Immunisations recommended for Health Care Workers.
New staff or any existing staff who know they are not already protected should contact the
occupational health department to arrange vaccination without delay.
C. Safe working practice
Please see ‘safe handling of sharps section 2.4.
4.2.
Occupational sharps or splash Injuries acquired by ACE staff
A sharp injury/contamination incident includes:
Inoculation of blood by a needle or other ‘sharp’
Contamination of broken skin with blood
Blood splashes to mucous membrane e.g. eyes or mouth or nose
Swallowing a person’s blood e.g. after mouth to mouth resuscitation
Contamination where clothes have been soaked by blood
Human bite where skin is broken.
All staff must be aware of the location of their ‘sharps /splash injury resources box’
In the event of a sharp injury/contamination incident all ACE staff should access their
sharps splash injury resource box and refer to The Management of Needlestick and
Sharps Injury Clinical policy ACE45.
Owner: Infection Prevention and Control Team
Version 6.1
Page 22 of 104
Review: December 2014
SECTION 5 – STAFF HEALTH
The purpose of this document is to ensure that every member of staff
understands their individual responsibility regarding staff health.
5.1.
Introduction
This guideline sets out the procedures for staff to follow for staff health.
It is also a guide for General Practice in the event that their patients seek ad
hoc occupational health advice.
5.2.
Staff Health
Immunisations recommended for Health Care Workers (HCWs)
All new HCWs should undergo a pre-employment health assessment, which
should include a review of Immunisation needs. The Control of Substances
Hazardous to Health (COSHH) Regulations 2002 require employers to assess
the risks from exposure to hazardous substances, including pathogens (called
biological agents in COSHH) and to bring into effect the measures necessary
to protect workers from these risks as far is reasonably practicable.
Any vaccine-preventable disease that can be transmitted from person to
person poses a risk to both healthcare professionals and their patients. HCWs
have a duty of care towards their patients, which includes taking precautions
to protect themselves from communicable disease. Immunisation of HCWs
therefore aims to:
Protect patients, including vulnerable patients who may not respond
well to their own immunisation
Protect the individual and their family from an occupationally-acquired
infection
Protect other staff
Allow for the efficient running of services without disruption
The Occupational Health Department should therefore assess HCWs for the
types of Immunisations that may be appropriate as follows:
A BCG is recommended for HCWs who may have close contact with
infectious patients and those working in Maternity and Paediatric
departments and areas where patients are likely to be
immunocompromised e.g. Transplant, Oncology and HIV units
Hepatitis B vaccination is recommended for all HCWs who may have
direct contact with patients’ blood or blood stained body fluids. This
includes staff who are at risk from blood–contaminated sharp
instruments, or of being bitten or deliberately injured by patients. (Usual
dose is 3 injections and then antibody titres for Hepatitis B should be
checked 8-12 weeks after completion of this primary course of
vaccination. This will enable appropriate decisions to be made
Owner: Infection Prevention and Control Team
Version 6.1
Page 23 of 104
Review: December 2014
concerning post-exposure prophylaxis following known or suspected
exposure to the virus.
Measles, Mumps and Rubella (MMR) documented evidence required
of having received 2 doses of MMR or evidence of a positive antibody
test for MMR.
All staff should be up to date regarding Diptheria, Tetanus and Polio
(DPT)
Responders with anti-HBs levels greater than or equal to 100mIU/ml do
not require any further primary doses. A reinforcing dose at 5 years is
recommended but no further assessment of antibody levels is required.
Responders with anti-HBs levels of 10 to 100IU/ml should receive one
additional dose of vaccine at that time. They should also receive the
reinforcing dose at 5 years. Again no further assessment of antibody levels
is required.
An antibody level below 10mIU/ml is classified, as a non-response to the
vaccine and testing for markers of current or past infection is good clinical
practice. In non-responders, a repeat course of vaccination is
recommended, followed by re-testing 8-12 weeks after the second course.
Those who still have antiHBs levels below 10IU/ml, and who have no
markers of current or past infection, will require Hepatitis B
immunoglobulin (HBIG) for protection if exposed to the virus.
If, after completion of a risk assessment, it is considered that the risk to
either the non-responder HCW and/or their patients is too high, then
redeployment of the non-responder HCW may need to be considered.
Staff who sustain a sharps injury must refer and follow Needlestick and
Contamination Injuries Procedure ACE45.
Influenza immunisation helps to prevent influenza in staff and may also
reduce the transmission of influenza to vulnerable patients. It is
recommended that all staff involved in direct patient care takes the
opportunity to be vaccinated an annual basis.
Varicella vaccine is recommended for susceptible HCWs who have
direct patient contact. Those with a definite history of chicken pox or
herpes zoster (shingles) can be considered protected. HCWs with a
negative or uncertain history should be serologically tested and vaccine
offered to those without the varicella zoster antibody. (2 doses of
vaccine 4-8 weeks apart)
Both staff and the Occupational health department should keep a record of
staff immunisation histories; to facilitate action should an incident occur.
Owner: Infection Prevention and Control Team
Version 6.1
Page 24 of 104
Review: December 2014
5.3. Staff who perform Exposure Prone Procedures (EPPs)
Exposure Prone Procedures are those invasive procedures where there is a
risk that injury to the worker may result in the exposure of the patient’s open
tissues to the blood of the worker. Such procedures occur mainly in surgery
(including some minor surgery carried out by GPs), obstetrics and
gynaecology, dentistry and some aspects of midwifery. Most nursing duties do
not involve EPPs; exceptions include A&E and some aspects of theatre
nursing. (Hepatitis B infected healthcare workers and antiviral therapy, DH,
March 2007)
Generally staff in the community do not perform EPPs with the exception of
Dentists in Dental Practices and Podiatric Surgeons. However, all staff who
do perform EPPs need to be aware of their obligations to declare it if they
know themselves to have been at risk of exposure to a blood borne virus
infection (Hepatitis B, C or HIV). Staff should ensure that they are familiar
with the statement of their professional body to this matter.
If a HCW is infected with HIV or Hepatitis C (RNA positive), they may not
perform EPPs. They must seek confidential advice from the Occupational
Health Department. Further guidance is available from Department of Health,
HIV infected healthcare workers: guidance on management and patients
notification, July 2005. Healthcare workers who are infected with Hepatitis B
in certain instances may be allowed to undertake EPPs while taking
continuous oral antiviral therapy, provided that the necessary safeguards are
in place. This requires a case-by-case assessment by a Consultant
Occupational Physician. See Department of Health, Hepatitis B infected
healthcare workers and antiviral therapy, March 2007
5.4. Staff with Potentially Infectious Diarrhoea or any other infectious
disease
Clinical staff and food handlers who develop diarrhoea and/or vomiting of an
unexplained or of a potentially infectious nature should report this to the line
manager and Occupational Health Department. The staff member should
stay off work until they have been symptom free for 48 hours. Staff may be
asked to submit stool specimens to their GP.
Staff with a suspected or known infectious disease should be referred to
Occupational Health for advice on when to return to work and if the infection
should be referred to the workplace manager if patients may have been put at
risk of infection.
Owner: Infection Prevention and Control Team
Version 6.1
Page 25 of 104
Review: December 2014
5.5. Staff Potentially Exposed to a Blood-borne Virus
HCWs have a duty of care to patients to promptly seek and follow confidential
professional advice if for any reason they believe they may have been
exposed to infection with a blood borne virus e.g. Hepatitis B or C or HIV.
For needle stick or body fluid contamination injury please refer and follow
Needlestick and Contamination Injuries Procedure ACE45.
5.6. Health Clearance for TB, Hepatitis B & C and HIV: New Healthcare
Workers; Department of Health March 2007
All new (HCWs) need to have standard health clearance before they have
clinical contact with patients, as follows:
o be free from TB disease with immunisation where appropriate
o to be offered immunisation against Hepatitis B
o to be offered pre-test discussion and tests for Hepatitis C and
HIV

This includes students entering training as a HCW

New HCWs to the NHS

New Dentists

Those returning to the organisation who may have been
exposed to serious communicable disease (Risk
assessment required)

Locum and agency staff and the independent sector staff
In addition, ALL new HCWs to the organisation who will perform Exposure
Prone Procedures (EPP) and existing workers who will be performing EPPs
for the first time, must provide evidence that they are not carriers of HIV,
Hepatitis C and Hepatitis B
This includes Dental staff and staff who perform podiatric surgery
All healthcare workers are reminded of their responsibility to seek professional
advice about the need to be tested if they have been exposed to a serious
communicable disease
This guidance is intended not to prevent those infected with BBVs from
working in the NHS but rather to restrict them from working in those clinical
areas where their infection may pose a risk to patients in their care
NICE guidance on TB advises that HCWs must not work with patients until
they have completed a TB screen to include;
o Assessment of personal or family history of TB
o Symptom and signs enquiry (may be by questionnaire)
o Documented evidence of tuberculin skin testing and /or BCG
scar checked by an Occupational Health professional
Owner: Infection Prevention and Control Team
Version 6.1
Page 26 of 104
Review: December 2014
o Documented tuberculin skin test result within 5 years, if
available
If no (or inconclusive) evidence of prior BCG vaccination a Mantoux
tuberculin skin test should be performed. (Employees who are Mantoux
test negative should have an individual risk assessment for HIV before
BCG vaccination is given.)
Employees new to the organisation should be offered BCG vaccination
whatever their age, if they will have contact with patients or clinical
specimens, are Mantoux negative and have not been previously
vaccinated
New entrants to the UK from countries of high incidence of TB are
recommended to have a chest X-ray
HCWs of any age from countries with high TB incidence who have had
contact with patients in settings with a high TB prevalence should have
a Mantoux test
o If negative, treat as above
o If positive, refer to chest clinic for assessment and consideration
of treatment for disease or latent infection
All staff should have annual reminders of the signs and symptoms of
TB
5.7.
Occupational Health for Other Employers
GPs are not required to offer vaccinations that other employers have
suggested their staff should have, unless they have a specific contract to do
so.
Individuals’ requesting such vaccinations should be sent back to their
employer to arrange an appropriate occupational health facility, unless the GP
considers an immediate risk exists.
Hepatitis B vaccine given for occupational protection
Hepatitis B immunisation is recommended for those who have direct contact
with blood or blood stained body fluids.
These include:Health care workers
Dental nurses
Staff and residents of residential accommodation for those with severe
learning disabilities
Morticians and embalmers
Prison service staff
Tattooists
Emergency services
Owner: Infection Prevention and Control Team
Version 6.1
Page 27 of 104
Review: December 2014
Patients may seek immunisation at the advice of their employer. In principle,
large employers and institutions who require that their employees be
immunised should provide this through their own Occupational Health
Department. Where such an employer is failing to do this it is recommended
that the employee raise the matter with the local Health and Safety Executive
office (0845 345 0055).
Food Handlers
For all information regarding food handlers please refer to the Environmental
Health Department at the relevant Local Authority
Owner: Infection Prevention and Control Team
Version 6.1
Page 28 of 104
Review: December 2014
SECTION 6 – MANAGEMENT OF INFECTIOUS DISEASES
The purpose of this section is to ensure that every member of staff has an
understanding of the most common infectious diseases.
Please also refer to the “Guidelines for the Control of Outbreaks of infection
including surveillance and notification procedures for infectious diseases”,
Clinical Policy ACE314 and “Section 8.3 of these guidelines Barrier Nursing
(Isolation of Patients)”.
It is important that the Inter-Healthcare Patient Infection Prevention &
Control Transfer form is completed when a patient is transferred or
discharged from community hospitals/inpatient units. This should be
completed whether a patient presents an infection risk or not. This form may
also be completed for patients being admitted into hospital/inpatient units from
the community (See appendix 10)
6.1.
Fact Sheets
You can view factsheets and information on management of infectious
diseases clicking the links below.
HPA Website (Accessed 02/12/2011)
http://www.hpa.nhs.uk/
A-Z of infectious diseases (Accessed 02/12/2011)
http://www.hpa.nhs.uk/servlet/Satellite?p=1197382228184&packedargs=n
ull&childpagename=HPAweb%2FPage%2FHPAwebAutoListName&pagen
ame=HPAwebWrapper&c=Page&cid=1190280169369
Fact Sheets for Communicable Diseases (Accessed 02/12/2011)
http://www.hpa.nhs.uk/webw/HPAweb&Page&HPAwebAutoListName/Pag
e/1198504875113?p=1198504875113
6.2.
Table of Common Infectious Diseases
The following table is a quick reference to the common infectious diseases
and describes:
a.
b.
c.
d.
e.
Incubation Period
Method of Spread
Period of Infectivity
Exclusion Period from school/nursery/etc
Management of contacts
Specific advice on treatment should be sought from a medical microbiologist.
Owner: Infection Prevention and Control Team
Version 6.1
Page 29 of 104
Review: December 2014
INCUBATION PERIODS OF THE COMMONER COMMUNICABLE DISEASES
(References Communicable Disease Control Handbook – Dr J Hawker, Dr N Begg, Dr Iain Blair, Dr R Reintjes & Prof J Weinberg)
DISEASE
Chickenpox
Varicella-zoster
virus
NORMAL
INCUBATION
PERIOD
2 – 3 weeks
Usually
15 – 18 days
METHOD OF
SPREAD
Direct contact with
lesions and Inhalation
PERIOD OF
INFECTIVITY
NORMAL PERIOD OF
EXCLUSION
MANAGEMENT
OF CONTACTS
From shortly before the
rash appears until the
scabs are dry
Until scabs are dry –
usually 5 – 7 days after
appearance of last crop
of lesions
If a pregnant woman
is in contact with a
case of chickenpox
and her own history
is unclear. Urgent
advice must be
sought from a
medical
microbiologist as
VZIG may be
appropriate
During the course of
active infection (could be
up to 14 days)
From months to years
Exclusion is not
necessary unless an
outbreak occurs
Until clinically well
NB Shingles (herpes
zoster)
is caused by a reactivation of the
chicken pox virus
Vaccine
preventable
Conjunctivitis
24 – 72 hours
Direct or Indirect
contact
Cytomegalovirus
Uncertain
Contact with saliva,
blood, urine, breast
milk, semen, vaginal
secretions of an
infected person
Diarrhoea and
Vomiting
Campylobacter
(bacteria)Clostridium Difficile
(bacteria)
Up to 10 days
(Usually 2 – 5
days)
Ingestion/faecal/oral
(undercooked meat)
Whilst Diarrhoea is
present
Until 48 hours after first
normal stool
Spore forming
bacterial that can
live in the
environment for
indefinite periods
Usually pre disposing
factor of history of
antibiotics.
Person to Person
Whilst Diarrhoea is
present
Until 48 hours after first
normal stool
Owner: Infection Prevention and Control Team
Version 6.1
NB Infection is
generally
asymptomatic, but
primary infection
during pregnancy
may result in fetal
infection and
congenital
abnormality
For ACE premises
report Cases to
Review: December 2014
Page 30 of 104
DISEASE
Cryptosporidium
(Protozoan)
E. Coli 0157
(VTEC)
(bacteria)
NORMAL
INCUBATION
PERIOD
1 – 28 days
usually 7 – 10
days
1 – 9 days
(Usually 3 - 4
days)
METHOD OF
SPREAD
PERIOD OF
INFECTIVITY
NORMAL PERIOD OF
EXCLUSION
MANAGEMENT
OF CONTACTS
Infection Control
Team.
If a care home report
or member of the
public report cases to
the Essex Health
Protection Unit
Ingestion/faecal/oral
(contaminated water)
As long as organism is
present
Until 48 hours after first
normal stool
Contaminated
livestock/food
Ingestion/faecal/oral
(can cause
haemorrhagic colitis
and HUS)
Person to person, Air
borne
As long as organism is
present
For food handlers: Until
organism is cleared for
2 consecutive negative
faecal specimens
As long as organism is
present
Until 48 hours after first
normal stool
Norovirus
(Norwalk like virus
and small round
structured virus)
Giardia
(Protozoan)
1 – 2 days
5 - 25 days
Ingestion/faecal
Whilst cysts are present
in stools but mainly
whilst
Until 48 hours after first
normal stool
Salmonella
(bacteria)
12 – 72 hours
Ingestion/faecal
(reptiles and birds
reservoir)
Diarrhoea is present
Until 48 hours after first
normal stool
Faecal/oral and food
contamination
As long as organism is
present
Shigella
(Dysentery)
1 – 7 days
As long as organism is
present
For ACE premises
report Cases to
Infection Control
Team.
If a care home report
or member of the
public report cases to
the Essex Health
Protection Unit
Until 48 hours after first
normal stool
All possible incidences of food poisoning should be notified to the Essex Health Protection Unit 0845 1550069
Glandular Fever
4 – 6 weeks
Saliva
Prolonged
Until clinically well
(Epstein Barr Virus)
May persist for a year
after infection
Hand, foot and
3 -5 days
Direct contact with
Immediately before and
Until clinically well
Mouth Disease
nasal and throat
during acute stage of
(virus)
secretions and
illness, perhaps longer
droplet. Contact with as the virus may be
Owner: Infection Prevention and Control Team
Version 6.1
Review: December 2014
Page 31 of 104
DISEASE
NORMAL
INCUBATION
PERIOD
METHOD OF
SPREAD
PERIOD OF
INFECTIVITY
faeces of infected
person
Head to Head contact
of 1 minute or longer
present in faeces for
weeks
Whilst lice or viable eggs
are present
NORMAL PERIOD OF
EXCLUSION
Head lice
(insect)
Eggs hatch and
become mature in
1 – 2 weeks
Hepatitis A
(virus)
2 – 6 weeks
(commonly 28
days)
Faecal – oral spread.
May also be spread
by contaminated food
or water.
Occasionally through
blood
A week before the onset
of illness until 7 days
after jaundice first
appears.
Seven days from onset
of jaundice and when
clinically well
Hepatitis B
(Blood Borne Virus)
Preventable by
vaccination
3 – 6 months
Predominantly blood,
semen, and vaginal
secretions, but also
found in other body
fluids
From many weeks
before symptoms
develop until shown to
be serologically negative
(indefinitely in the
chronic carrier stages)
Exclusion not
necessary, unless
clinically unwell.
Hepatitis C
(Blood borne virus)
1 –2 months
Predominately blood
but also found in
other bodily fluids
Whilst infection is
present in blood it will
remain infectious to
others
Exclusion not
necessary, unless
clinically unwell.
Owner: Infection Prevention and Control Team
Version 6.1
Review: December 2014
Page 32 of 104
There is no need to
exclude
MANAGEMENT
OF CONTACTS
Inspect all contacts
and treat only those
who have live head
lice. Inform all close
contacts so can be
treated if live lice
found.
Consider vaccination
of close contacts
(within 7 days)
HNIG if over 7 days
and at risk of adverse
outcome from hep A.
Vaccinate with HAV
at same time.
Vaccine, and in some
circumstances HBIG
may be required for
contacts. Urgent
referral to
GUMedicine clinic
may be required for
sexual contacts.
Refer all cases to
Genito-urinary
medicine clinic to
ensure appropriate
contact tracing.
Refer to
Gastroentrologist to
ensure appropriate
follow-up.
DISEASE
Herpes Simplex
(Cold sores and
genital herpes)
(virus)
HIV
Human
Immunodeficiency
Virus
(Blood Borne Virus)
Impetigo
(bacterial skin
infection)
NORMAL
INCUBATION
PERIOD
2 – 12 days
METHOD OF
SPREAD
Direct contact with
lesions.
PERIOD OF
INFECTIVITY
NORMAL PERIOD OF
EXCLUSION
A person may remain
infectious for life.
Dormant virus may reactivate.
Life long
None
Until the lesions are
healed or until 24 hours
after the start of effective
treatment
Up to 7 days after the
onset of symptoms
At least 24 hours after
commencement of
treatment
Variable
Predominantly blood,
semen, vaginal
secretions and breast
milk
1 – 4 days
Direct contact with
lesions
Influenza
(seasonal flu –
Virus)
Annual Vaccination
available for “at risk
groups”
Legionella
(bacteria causes
legionnaires
disease a form of
pneumonia)
1 -3 days
Droplet and indirect
spread from
contaminated hands
2 – 10 days
Inhalation of air that is Legionella is not passed
contaminated with
person to person
water droplets
containing legionella
bacteria
None
Leptospirosis
(Weils Disease)
(bacteria spread in
animal urine)
7 – 13 days
Up to 2 weeks
None
Lyme Disease
(bacteria)
3 –32 days
Direct or indirect
contact with Urine
from infected wild
animals or rats.
Contaminated water
(rivers etc) (including
sewers/sewage)
Borrelia Burgdorferi
bacteria transmitted
Lyme disease is not
passed from person to
None
Owner: Infection Prevention and Control Team
Version 6.1
Review: December 2014
Page 33 of 104
None
Until clinically well
MANAGEMENT
OF CONTACTS
Refer to GenitoUrinary medicine
clinic for genital
herpes
Refer to Genitourinary medicine
clinic to ensure
appropriate contact
tracing
Annual Vaccination
for risk groups is
recommended Antiviral treatment may
be prescribed for ‘at
risk’ contacts.
All cases must be
reported to the Health
Protection Agency to
ensure appropriate
environmental
investigation
No contact tracing
but a notifiable
disease
DISEASE
Measles
(Virus and Vaccine
preventable MMR)
NORMAL
INCUBATION
PERIOD
8 – 13 days
(Usually 10 days)
METHOD OF
SPREAD
PERIOD OF
INFECTIVITY
to humans by bite
from infected tick
person
Respiratory droplet,
nose or throat
secretions or articles
soiled with these
secretions.
From slightly before the
onset of fever and 4
days before and 4 days
after the appearance of
rash
NORMAL PERIOD OF
EXCLUSION
Until 4 days after the
onset of rash
MANAGEMENT
OF CONTACTS
Vaccination of
unimmunised
contacts is urgent.
HNIG may also be
required. Salivery
diagnostic kit
available from Essex
HPU
Meningitis: - Inflammation of the lining of the brain and spinal cord, maybe caused by bacteria, viruses and fungi
It is essential that if meningitis is suspected medical help is sought urgently as prompt treatment can be life saving. The cause will not be
known until further investigations occur. (Please see section following this table).
Bacterial causes include: a) Meningococcal
2 – 10 days (3-4
Spread by droplets,
Until 24 hours effective
Until clinically well
Inform Essex Health
disease (meningitis mean)
usually only to close
antibiotic therapy
Protection Unit
and/or septicaemia)
contacts e.g.
immediately
Neisseria
household or kissing
suspected – 0845
meningitidis
contacts
1550069 for contact
(groups B & C in
tracing. No reason to
UK)
exclude close
contacts from school
etc.
b) Haemophilus
Influenzae type B
2 – 4 days
Spread by droplets,
Until 24 hours effective
Until clinically well
Inform Essex Health
(rare since Hib
usually only to close
antibiotic therapy
Protection Unit
vaccine introduced)
contacts e.g.
immediately
household or kissing
suspected – 0845
contacts
1550069 for contact
tracing. No reason to
exclude close
contacts from school
etc
Owner: Infection Prevention and Control Team
Version 6.1
Review: December 2014
Page 34 of 104
NORMAL
DISEASE
INCUBATION
PERIOD
c) Streptococcus Pneumoniae
(Pneumococcal) (2 vaccines available)
Viral Meningitis
Variable
Molluscum
Contagiosum
Mumps
(Vaccine
preventable MMR)
Usually
9 – 50 days but
can be anywhere
from 7 days to 6
months
2 – 3 weeks
METHOD OF
SPREAD
PERIOD OF
INFECTIVITY
NORMAL PERIOD OF
EXCLUSION
No Public Health action required
Droplet spread of the
virus is infectious but
not the meningitis
Direct contact with
the lesions
Usually 7 days
Until well
Unknown but probably
as long as the legions
persist
None
Respiratory droplets
or Saliva
From 7 days before to 9
days after parotid glands
first swell
Until 9 days after
parotid gland first
swells
Parvovirus B19
(Slapped cheek
syndrome)
After 4 – 20 days
(usually 13 – 18
days)
Droplet. Rarely from
mother to unborn
baby
7 days before the onset
of rash, until the onset of
rash
Until clinically well
Ringworm (fungal
infection of the
skin)
2 – 3 weeks
Skin to skin contact
from infected lesions
or indirect from
equipment e.g.
showers, toilet
articles or clothing
As long as lesions
persist or until
medication is started
Not necessary
Tinea Capitis
Owner: Infection Prevention and Control Team
Version 6.1
Review: December 2014
Page 35 of 104
MANAGEMENT
OF CONTACTS
Reassure and advice
to Contacts
No management of
contacts required but
reassure and advice
Consider vaccination
of unimmunised
contacts. Notify
cases to Essex
Health Protection
Unit, who will advise
on need for salivary
test
Notifiable Disease
In pregnancy, it must
be ensured that the
women’s obstetrician
is informed of their
contact with
Parvovirus so that the
unborn fetus can be
monitored
Close contacts i.e.
household and
school contacts
should be checked
and treated if
required
DISEASE
(scalp infection)
(Laboratory
methods should be
used to confirm
diagnosis)
Rubella
NORMAL
INCUBATION
PERIOD
METHOD OF
SPREAD
PERIOD OF
INFECTIVITY
NORMAL PERIOD OF
EXCLUSION
MANAGEMENT
OF CONTACTS
2 –3 weeks
Droplet-coughing or
direct contact with
secretions from nose
and throat
A week before to 4 days
after appearance of rash
For at least 4 days
after the appearance of
the rash
Up to 8 weeks
before the onset
of itching in
persons not
previously
exposed.
Possibly straight
away if previously
exposed.
1 – 4 days
Prolonged direct skin
to skin contact,
sexual contact or
rarely transferred
from clothes or bed
linen
Until after effective
treatment with scabicidal
cream
Until after the first
application of effective
treatment
Notify to Essex
Health Protection
Unit, who will advise
on need to test
saliva. Consider
vaccination of
unimmunised
contacts. In pregnant
women, who have
been in contact with a
case, and their
immune status is
unknown-consult the
local microbiologist.
All close contacts to
be treated in the
same 24 hours. For
outbreaks in
residential
establishments (e.g.
care homes) contact
the Essex Health
Protection Unit
Droplet
Until 48 hours after
antibiotic medication is
started
As long as the lesions
remain wet
Until 48 hours after
medication is started
(Vaccine
preventable MMR)
Scabies
Scarlet Fever
(Group A
Streptococcus)
Shingles
(Re-activation of
virus which is
Shingles cannot be
caught from a person
infected with shingles,
Owner: Infection Prevention and Control Team
Version 6.1
Review: December 2014
Page 36 of 104
Until the rash has
crusted/dried
In pregnant women,
who have been in
contact with a case,
DISEASE
NORMAL
INCUBATION
PERIOD
caused by previous
chicken pox
infection)
Threadworms
Toxoplasmosis
(parasite)
Tuberculosis of
lung (PTB)
(bacteria –
mycobacterium
tuberculosis
complex)
Infective embryos
develop within 5 –
6 hours of
ingestion of eggs
10 – 25 days
Usually 3 – 8
weeks
(sometimes as
long as 12 weeks)
METHOD OF
SPREAD
but if not immune to
chickenpox,
chickenpox can be
caught through
contact with fluid from
the shingles legions
and throat secretions
Faecal – oral.
Spread of eggs from
scratching anal area
PERIOD OF
INFECTIVITY
NORMAL PERIOD OF
EXCLUSION
MANAGEMENT
OF CONTACTS
and their immune
status to chicken pox
is unknown-consult
the local
microbiologist
Until after effective
treatment
Not necessary just
ensure good hand
hygiene
Treat whole family at
the same time and
repeat one week later
Ingesting water, food
or soil contaminated
with faeces from
infected cats or meat
infected with cyst
form of parasite.
Mother to foetus
spread.
Droplet
(Spread usually
requires close and
prolonged contact)
Cysts from parasite may
remain for life
No exclusion,
treatment only required
for those at greater risk
of severe
Toxoplasmosis e.g.
immuno-compromised
Risk if women
catches during
pregnancy of
congenital
Toxoplasmosis –
seek expert guidance
on treatment.
Until 2 weeks after start
of effective treatment
Until 2 weeks of
effective treatment
Contact tracing in
household and
household equivalent
contacts must take
place. This is usually
arranged via the
hospital consultant
caring for the patient
None
Not infectious
None
None
Targeted BCG
vaccination
programme
Extra pulmonary
TB (other parts of
the body)
Owner: Infection Prevention and Control Team
Version 6.1
Review: December 2014
Page 37 of 104
DISEASE
Verrucas (warts)
(Virus)
Whooping cough
(Pertussis)
(bacteria)
NORMAL
INCUBATION
PERIOD
2 – 3 months
6 - 20 days
METHOD OF
SPREAD
Direct contact
Direct contact with
discharges from
respiratory tract of
inhalation or airborne
droplets
PERIOD OF
INFECTIVITY
NORMAL PERIOD OF
EXCLUSION
Unknown but at least as
long as visible lesions
persist
From 6 days after
exposure to 21 days
after onset of typical
paroxysms
Not necessary but
cover when taking part
in communal activities
Until cough subsides
and clinically well (at
least completing 5 days
of a 7day course of
antibiotics) Must start
treatment within 21
days of onset. Exclude
for at least three weeks
if untreated
(vaccine
preventable)
Owner: Infection Prevention and Control Team
Version 6.1
Review: December 2014
Page 38 of 104
MANAGEMENT
OF CONTACTS
All household
contacts should be
offered a 7 day
course of
erythromycin or
clarithromycin if
children who have
not received a full
course of vaccine
(including the
preschool booster)
6.3.
Guidelines for the Management of Clostridium Difficile
Please refer to the Policy and Procedure for Prevention and
Management of Clostridium difficile associated Disease (CDAD) in the
community hospitals” Clinical Policy ACE84
6.4. Guidelines for caring for a patient with Extended- Spectrum BetaLactamase producers (ESBLs)
What does ESBL mean?
ESBL stands for extended spectrum beta- lactamase. These are enzymes
produced by many species of bacteria which destroy and make them resistant
to some of the most widely used antibiotics, e.g. cephalosporins, This can
cause problems when treating infected patients as there are only 2 oral
antibiotics (e.g. nitrofurantoin) and a limited group of IV antibiotics that remain
effective. This can complicate and/or delay appropriate treatment.
ESBLs were first described in mid 1980s and were found mostly in Klebsiella
species, in hospitals treating the most vulnerable patients. Since 2003 a new
class (CTX-M enzymes) has emerged, found in Escherichia coli bacteria,
most often causing urinary tract infections, which are also resistant to
penicillins. This can progress to the serious disease, septicaemia. They have
been found in the community as well as in hospitals although “community
acquired“ infections may have had previous contact with hospitals.
How are they spread?
There is some evidence suggesting they can be found in the faeces of farm
animals as well as some humans. This means that it is possible that
transmission may occur from contamination of food, e.g. raw meat and by
bacteria from animal faeces, leading to infections in humans.
It is also possible that these bacteria are passed from person to person on
contaminated hands (of patients or health care workers) or by poor practice in
urinary catheter care.
Spread is made easier if the bacteria normally present in the gut (and which
help protect against invasion by other strains) are killed by taking antibiotics.
Use of some newer antibiotics appear to predispose patients to infection with
ESBL producing bacteria which may explain why this has become an issue
now.
Who gets ESBL producing bacteria?
The majority of those with an ESBL producing strain are elderly and unwell
with another underlying medical condition. Often these patients have had
Owner: Infection Prevention and Control Team
Version 6.1
Page 39 of 104
Review: December 2014
multiple courses of antibiotics for repeated infections and have been in
hospital
It is possible that the ESBL producing bacteria are acquired months or even
years before they cause infection. They live harmlessly in the gut until the
patient becomes ill and requires antibiotics.
How can we control spread?
Effective control measures are less well understood than for other types of
antibiotic resistant bacteria for example MRSA.
Until we know more about how to control these bacteria, the following are
sensible precautions to take;
It should be ensured that hand washing and other infection control
procedures are rigorously enforced.
Encourage regular assessment of urinary catheter use; if the patient no
longer has a clinical need for a urinary catheter, remove it.
Antibiotics should only be prescribed when needed, in the right dose,
for the right duration, so as to reduce resistance developing in bacteria
In some circumstances patients with ESBL producing bacteria will be
isolated whilst in the acute hospital.
Can a person be cleared of an ESBL producing strain?
Sometimes the strain will be lost naturally.
In those with serious illnesses, ESBL producing strains may be present for
months or even years. Use of antibiotics probably does not help; they can
treat infections but do not necessarily eliminate the bacteria from the body
especially if there are some in the gut.
Ongoing initiatives
As this is an emerging health care problem, information will be published
when new details become available. The Health Protection Agency (HPA)
www.hpa.org.uk, have a number of ongoing initiatives:
Advice and assistance in treatment and management of patients
Awareness raising
Guidance on detection of ESBL organisms for laboratories
Studies into patient risk factors
Guidance to GPs on local updates of microbial resistance patterns
Owner: Infection Prevention and Control Team
Version 6.1
Page 40 of 104
Review: December 2014
CDC to be informed of serious infection with ESBL-producing E. coli
Increase surveillance for E. coli ESBL-producers or ciprofloxacin
resistance (bacteraemias and UTIs) and ESBL- producing
Klebsiella spp.
Collaboration with Department of environment, food and rural affairs
(DEFRA), Veterinary laboratory agency (VLA) and Food standards
agency (FSA), as food chain may be possible source.
PVL- associated Staphylococcus aureus
What is PVL Staphylococcus aureus?
Panton Valentine Leukocidin (PVL) is a toxic substance produced by some
strains of Staphylococcus aureus, which is associated with an increased
ability to cause disease. PVL can be produced by methicillin sensitive and
methicillin resistant strains of S. aureus. Most of the PVL positive S.
aureus strains identified in the UK are sensitive to many antibiotics and are
of low incidence at present but healthcare professionals and the public
should be aware of the infections it can cause and the precautions
required. It is important to diagnose infection early and it is usually
successfully treated with antibiotics. The small numbers reported have
usually been in the community and not hospital acquired. Young children
and young adults are more commonly infected.
What are the symptoms?
Not all people with PVL Staphylococcus aureus will suffer an infection.
Infections are usually caused by risk factors such as skin abrasions e.g.
from close contact sports, or sharing contaminated items i.e. razors, towels
etc, or from damaged skin e.g. eczema, such infections include:
Cellulitis
Abscesses, boils and carbuncles
Occasionally , more invasive disease e.g. septic arthritis,
bacteraemia or necretising pneumonia
Prevention
Risk of infection is small, but good hygiene practices should be maintained
Standard precautions including thorough hand washing and drying and
use of alcohol hand rub if hands are not visibly soiled
Environment to be kept clean and dry
Wounds should be cleaned and covered
Do not touch other peoples wounds, dressings etc.
Visitors and staff must wash hands
If infection spreads or recurs go to GP or A & E for investigation
Owner: Infection Prevention and Control Team
Version 6.1
Page 41 of 104
Review: December 2014
Bath/shower and change linen and underwear regularly
Do not share toothbrushes, towels, razors etc
In shared facilities, e.g. gyms, wash hands with liquid soap and water,
ensure equipment is cleaned between use and that there is good
ventilation in locker room and showers
PVL is not a new phenomenon, and was probably in existence before the
1930s when Panton and Valentine first described it. It is unlikely to become
widespread although we need to be aware of it and be able to recognise and
manage infections caused, promptly.
6.5.
Prevention and Control of Headlice in the Community
Introduction
The aim of this section is to promote a co-ordinated approach to the
prevention and treatment of head lice. The document has been drawn up by
a multidisciplinary team to offer a consistent and methodical approach to the
control of Headlice.
Headlice are transferred from person to person wherever people congregate
i.e. schools, playing fields, parks and homes, brownies, scouts etc. However
the home is the most common place where transfer of lice occurs.
It is the responsibility of the parent/carer to check their child’s head regularly,
and to treat when head lice are found. If, however, the parent/carer has
concerns, assistance can be gained from the School Nurse, Health Visitor,
Practice Nurse, Pharmacist or GP.
Headlice is a problem of the community, NOT of the school
Half the people with head lice are adults or pre-school children. Many
infected adults and some newly infected children do not itch and are unaware
they have head lice. Most infections are caught out of school. Parents and
other relatives are frequent sources of head lice. Head lice are transferred by
direct head to head contact lasting around one minute.
With the correct treatment, and proper contact tracing, lice can be controlled
in the community.
Some facts about Headlice and Nits (Pediculus Humanus Capitis)
The headlouse is a small insect, which feeds by sucking blood and likes to
stay close to the scalp for warmth.
The head of a headlouse bears two five-jointed antennae. At the top of each
is a dish-shaped depression containing heat sensitive hairs, called papillae. If
the tip of either antenna registers a temperature of less than 31ºC, then the
Owner: Infection Prevention and Control Team
Version 6.1
Page 42 of 104
Review: December 2014
insect turns toward the warmer side. This keeps the lice tight against the skin,
near to their only food source, blood.
Headlice, therefore, have an invisible territorial boundary, the 31ºC contour,
outside which they will not voluntarily go. All their eggs are glued onto the hair
close to the scalp within this warm zone, which means that nearly all are laid
at the base of hair shafts. Within their warm zone, the insects spread out over
the scalp quite evenly. They only seek each other in order to mate.
The human louse cannot live on any other animal. It moves by crawling on
hair and can neither jump nor fly. It grows to full size (a little smaller than a
match head) in about 10 days, with a life span of perhaps two weeks. Whilst
growing it changes it’s skin three times. Cast skins and louse faeces (which
look like black dust) may be found on the pillows of infected people.
The female lays five to eight flesh coloured eggs glued to the base of the hair
each night. These take five to seven days to hatch. The empty eggshells,
called nits, grow out with the hair at about one centimetre per month.
Lice move fast and can easily be missed when a head is inspected. They
have no particular preference for hair colour, length or state of cleanliness.
Vigorous combing injures head lice. An injured louse cannot grip onto the hair
and can easily be combed out.
Headlice infections cause itching in most children. This is a reaction to the
saliva of the louse. It may take some months of infection before a child
becomes sensitised enough to react by itching.
Re-infection may occur rapidly between intimate contacts.
Prevention
Children should have their own comb and be taught to use it. Children and
adults should comb their hair twice a day. This will help prevent any infection
becoming established.
Parents should use a fine-toothed comb, or preferably a head lice detection
comb purchased form the local chemist (community pharmacy), on wet hair
each week to check for lice. They should watch for signs of early infection
(black dust on the pillow) and use a detector comb if ever they suspect an
infection and whenever warned of a possible contact.
When washing hair, if the sink plug is inserted the water can be checked for
any lice that may have been washed off.
There are products, which claim to deter head lice infections from becoming
established. These are not routinely recommended.
Owner: Infection Prevention and Control Team
Version 6.1
Page 43 of 104
Review: December 2014
Headlice lotions (or shampoos) should not be used as a preventative
measure.
Detection Combing
Once a week at home, everybody’s head should be checked for head lice.
Using a head lice detection comb, or a very fine-toothed comb, comb through
(wet) hair in sections. If the hair is wet, lice will be easier to detect and comb
out. (Using a small amount of conditioner on the wet hair helps with detection
and removal of the lice). If lice are found, that person should be treated.
When one member of the household has been found to have head lice, all
other members of the household must be carefully checked using the
detection comb and other close contacts who may have had head to head
contact should be notified.
Treatment - for when Lice are found
Only treat those with a proven head lice infection.
There are two options for the treatment of head lice:
1. Wet Combing
This method does require perseverance but some parents may find it
preferable to using a chemical product on their child’s head. However,
if this treatment appears to continually fail, treatment with insecticides
may still be required.
Wash the hair in the normal way with an ordinary shampoo
Using lots of hair conditioner (approximately 3 times the amount
you would usually use) and while the hair is very wet; comb
through the hair form the roots with a fine-toothed comb/head
lice comb.
Make sure the teeth of the comb slot into the hair at the roots
with every stroke. This should be done over a pale surface,
such as a paper towel or the bath.
Clear the comb of lice between each stroke.
Wet lice find it difficult to escape, and hair, which is slippery from
conditioner, makes it hard for them to keep a grip – so removal
with the comb is easier.
When all the hair has been checked, rinse off the conditioner.
This routine should be repeated every day for 2 weeks, so that
any lice emerging from the eggs are removed before they can
mature, mate and lay more eggs.
Owner: Infection Prevention and Control Team
Version 6.1
Page 44 of 104
Review: December 2014
2. Insecticides
The Essex Health Protection Unit supports a Mosaic policy for the use
of insecticides. This means that no single insecticide is promoted at
any given point in time.
There are three main chemicals used. (Phenothrin, Malathion &
Carbaryl) Families can use those insecticides they find most effective.
Carbaryl can only be prescribed by a healthcare professional (e.g.
GP and some nurses), the other two chemicals can be bought over
the counter.
All must be used according to manufacturers guidance.
For individuals that suffer from asthma, eczema, etc, alcohol based products
should be avoided. Aqueous (water) based products are safe to use.
The following table indicates which products are aqueous and water based:
PHENOTHRIN
MALATHION
CARBARYL
Aqueous (water) Fullmarks liquid
based
Derbac M
Quellada M
Carylderm liquid
Alcohol based
Prioderm
Suleo M
Carylderm lotion
Fullmarks
Insecticides should ONLY be used if live lice are found.
Insecticides must not be used more than once a week, and not for more than
3 consecutive weeks.
Headlice shampoos and cream rinses are not recommended as they are poor
at killing head lice and do not kill eggs. They should not be used to get rid of
lice nor as a preventative measure.
After treatment, ensuring manufacturer’s guidance has been followed and the
lotion has been in contact with the hair for the recommended amount of time,
shampoo and condition the hair. Whilst the conditioner is still on the hair, use
a fine toothcomb to remove dead lice and nits. It could take up to 24hours for
lice to die, so do not assume the treatment has not worked.
To ensure the treatment has been successful, detection combing on wet hair
should be carried out on all treated persons three times during the next seven
days.
Owner: Infection Prevention and Control Team
Version 6.1
Page 45 of 104
Review: December 2014
Re-treat on the 7th day whether or not live head lice are found. This is to
ensure that lice hatching form any viable eggs are killed before they reach
maturity.
If very small lice are found – this could be due to eggs having survived
treatment and re-application with the recommended product should be
carried out 7 days after the initial treatment.
If large lice are found – re-infection from an outside source is likely.
There is evidence to show that infection and re-infection of school age
children is not primarily from within the child’s class, but from the
family, extended family and friends. A repeat treatment should take
place and careful contact tracing is required to identify the source of reinfestation.
Babies under the age of 6 months should only be treated under medical
supervision and if the presence of lice has been confirmed in their hair. If
there is a member of the family with a proven infection, un-infected babies
should simply have their hair combed with a detector comb daily for a week.
Small numbers of lice in babies can be managed and treated using the wet
combing method.
As chlorine may weaken the effect of insecticides, it is recommended that if
the person has been swimming in a chlorinated pool in the 72 hours before
treatment, their hair should be washed and dried before the lotion is applied.
The patient should not swim in a chlorinated pool for 48 hours after
application.
There is no reason to keep children away from school.
Contact Tracing
Contact tracing, is a vital part of the control of Headlice.
Contact tracing is the family’s responsibility. All close contacts including
grandparents, friends, social groups, playgroups and the school must be
considered as possible contacts.
The person with lice will have caught them from another person who already
had head lice and with whom they had head to head contact. That person will
be someone who is known to the family, and may not themselves be aware
they have lice.
Each person with head lice should formulate a list of every person they have
had head to head contact lasting one minute or more in the last month. This
list will be fairly short, but if the list is complete, the original donor of the head
lice can be identified.
Owner: Infection Prevention and Control Team
Version 6.1
Page 46 of 104
Review: December 2014
Every person on the list should then be told that they may have been in
contact with a person who has had head lice and that they should have their
own hair checked.
Alternative Therapies
Aromatherapy / Essential Oils
Many products are now available on the market. Advice from the Medical
Entomology Centre is that these products should not be recommended as a
method of treatment and/or prevention of head lice as:
1. There is no scientific evidence to support its effectiveness against
head lice.
2. Misuse in the application of such oils can easily occur and there have
been reports of children acquiring superficial burns as a result of oils
not being correctly diluted.
3. Some of the oils used in “head lice preparations” may aggravate
medical conditions, for example people who suffer from epilepsy and
asthma should avoid eucalyptus oil. To date no such warnings have
appeared on these preparations.
4. It is the physical act of combing that actually removes head lice from
the hair.
Non-Compliant Public
In the event of an individual failing to treat themselves or their child, a multi
disciplinary approach may be required. The following checklist, on page 73
can be used to assist.
Documentation
The aim of the checklist is to guide you through the strategy and to aid
documentation.
It is not intended that details of all potential and actual cases of head
lice should be documented in the checklist format.
It is anticipated that the checklist will rarely need to be completed. It will act
as an aide memoir to assist health and education professionals to direct the
individual to the most appropriate place for assistance e.g. if the parent did not
receive an information leaflet any professional could photocopy one for them
and ensure they understand what they need to do.
Any health or education professional can start using the checklist as the basis
for their documentation, and it can be passed on to the next professional
group as an onward referral is made.
Owner: Infection Prevention and Control Team
Version 6.1
Page 47 of 104
Review: December 2014
6.6. Prevention and Control of Scabies in the Community
Introduction
Scabies is an allergic response to an infestation of the skin by the mite
Sarcoptes scabiei. The mites penetrate through the skin and excavate
burrows at the epidermal/dermal junction. The female mite lays eggs, which
hatch after 3-4 days. Newly hatched larvae exit the burrows and appear on
the surface of the skin before forming their own tunnels. The burden of mites
can range from 10-20 to several thousand in people who are severely
immuno-compromised. Scabies is distributed worldwide and is endemic in
many developing countries.
Recognition of Symptoms
The most frequent symptom is itching which may affect all parts of the body
and is particularly severe at night.
Occasionally small vesicles may be visible along the areas where the mites
have burrowed. A papular rash may be visible in areas such as around the
waist, inside the thighs, lower buttocks, lower legs, ankles and wrists. Firm
nodules may develop on the front folds of the axillae and around the navel
and in males around the groin. Pale burrows described as a “grayish line
resembling a pencil mark” may be present in the skin between the fingers but
are less commonly seen than textbooks suggest.
Failure to find burrows does not exclude scabies as a diagnosis.
It should be emphasised that scabies may be difficult to recognise particularly
if scratching, inflammation or infection have obscured the presentation. Also
scabies can look atypical in anyone with immature or impaired immunity such
as very young children, those with Downs Syndrome, alcoholics or the very
elderly. In immunosuppressed people, such as those with AIDS or those on
immunosuppressive therapy, a more severe hyperkeratotic form may develop.
Mode of Transmission
Scabies mites are generally not capable of surviving off the host long enough
to establish a new infection as they quickly become too dehydrated and weak.
Mites are passed directly from the skin of one person to another. The
likelihood of transmission increases with the duration and frequency of skin-toskin contact.
Fomites and animals are not implicated in transmission.
Owner: Infection Prevention and Control Team
Version 6.1
Page 48 of 104
Review: December 2014
Incubation
The incubation period (development of itchy rash) is up to 8 weeks after
contact with an infected person, but may only be a few days if affected a
second time.
Outbreaks
Outbreaks occur particularly in residential/nursing homes, mental health care
establishments, long stay hospital wards and pre-school nurseries.
If an outbreak occurs in a care home, pre school establishment (or other area
not covered by the Organisation), the Essex Health Protection Unit should be
contacted (0845 1550069).
In the event of a suspected outbreak of scabies on ACE premises. Please
contact the Infection Control Team.
Treatment in a Community hospital Ward
When a single suspected case of scabies occurs in an community hospital
ward, the Infection Control Nurse should be alerted promptly to investigate. It
may be necessary to treat all patients and anyone with whom they have had
close contact.
If this action is required, it is important that all staff who have come into direct
contact with patients also treat themselves because they may be incubating
the disease without showing any symptoms. Family members of
asymptomatic staff need not be treated routinely but asked to report any later
symptoms.
As far as possible all staff members should receive the treatment on the same
day that their unit is treated. Staff should not work in any other area until
treatments have been completed throughout the ward.
Symptomatic people should be treated using 2 applications of scabicidal
cream at 7-day intervals. The Infection Control Nurse will make an individual
assessment and advise.
Treatment in a Household
Scabies is easily treated but the treatment must be done thoroughly and
conscientiously otherwise failure will occur.
Symptomatic cases in the community should be treated using 2 applications
of scabicidal cream at 7-day intervals. Their asymptomatic household
contacts should be given a single course of treatment at the same time as
the index case’s initial application of cream.
Owner: Infection Prevention and Control Team
Version 6.1
Page 49 of 104
Review: December 2014
People should be regarded as infectious until one application of scabicidal
cream has been applied.
Once treatment has commenced the person cannot transmit the mite.
Children need not be excluded from school or nursery having commenced
treatment.
If Scabies is left untreated for a long period of time it can have an
immunodepressive effect and cause a more severe form to develop.
LYCLEAR DERMAL CREAM IS THE TREATMENT OF CHOICE
Lyclear dermal cream is suitable for use by adults, including the elderly and
children over 2 months. Children between 2 month and 2 years should be
treated under medical supervision. Pregnant women should seek medical
advice.
Carefully follow the instructions enclosed with the cream (see below).
Ensure that the entire surface of the body is covered from the hairline
on the head down to and including the soles of the feet. This should
include the area behind the ears and the face, avoiding the area
around the eyes; otherwise the treatment may not be effective. If
the person to be treated has little or no hair the scalp should also be
included.
Areas of skin normally covered by extensive dressings should be
exposed, and Lyclear cream applied onto the intact skin up to and
around the wound. The dressing may then be replaced.
Apply the cream to clean, dry and cool skin. Do not apply following a
bath or shower.
Pay particular attention to the areas behind the ears, between the
fingers and toes, wrists, under the arms, external genitalia, buttocks
and under finger and toenails.
The whole body should be washed thoroughly 8 – 12 hours after
treatment.
Be sure to reapply any lotion washed off during the treatment period
e.g. after hand washing.
Directly after treatment, change bed linen and wear freshly laundered
clothes.
Owner: Infection Prevention and Control Team
Version 6.1
Page 50 of 104
Review: December 2014
Lyclear Dermal Cream disappears when rubbed gently into the skin. It
is not necessary to apply the cream until it remains detectable on the
surface.
Where possible, the cream is best applied by someone other than the
person receiving treatment. This makes it easier to get to difficult to
reach parts of the body.
It may be necessary to prescribe two tubes of cream to ensure all areas of the
body are covered thoroughly bearing in mind very dry areas of skin will absorb
more of the cream.
The following table shows the approximate amount of cream to be used as a
single application:
Adults and Children over 12 years
Up to 1 tube, may require up to 2
tubes but no more than 2 tubes.
Children aged 5 to 12 years
Up to half a tube
Children aged 1 to 5 years
Up to one quarter of a tube
Children aged 2 months to 1 year
Up to one eighth of a tube
NB following discussions with the Entomology Centre in Cambridge it is
now recommended to apply scabicide lotions/cream to the face avoiding
the area around the eyes.
This may conflict with some manufacturer’s guidance. However, there is
increasing evidence that scabies may also affect the face and failure to
treat this area could result in an incomplete and therefore unsuccessful
treatment.
Following Treatment
It is not uncommon for a person to have itching for up to 4 weeks after
successful treatment. Antihistamines may be helpful.
Owner: Infection Prevention and Control Team
Version 6.1
Page 51 of 104
Review: December 2014
6.7. Creutzfeldt – Jacob Disease (CJD)
Introduction
Creutzfeldt-Jacob Disease (CJD) is one of a rare group of diseases known collectively as
‘Transmissible Spongiform Encephalopathies’ (TSEs), which affect the structure of the brain
causing dementia and a range of neurological symptoms, including ataxia and jerky
movements.
A number of TSEs are recognised in both humans and animals.
In animals, the best-known TSE is bovine Spongiform Encephalopathies (BSE of ‘mad cow’
disease’). In humans, there are four main types of CJD: of these, sporadic CJD accounts for
85% of cases. The other types are familial, iatrogenic and variant CJD (vCJD).
At present, TSEs, including CJD, can only be reliably diagnosed by examination of brain
tissue, usually at post mortem. There is no definitive test for CJD, no proven treatment and the
disease is universally fatal.
Types of CJD
A. Sporadic CJD
First described in 1921. Sporadic CJD is most common in the over 50s, and affects about one
person per million per year worldwide. It is thought to arise spontaneously. Early symptoms
are usually of mental deterioration or behavioral disturbance. A rapidly progressive dementia
with obvious multifocal neurological involvement soon develops and within weeks the patient
may become unsteady on their feet, lacking in co-ordination and markedly clumsy. In some
people these are the first symptoms. Later symptoms may include blurred vision or even
blindness, rigidity in the limbs, sudden jerky movements, and incontinence. The course of the
disease is typically measured in months.
B. Familial or Genetic CJD (very rare)
Familial CJD has an autosomal dominant inheritance. The patients are often younger and the
duration of the illness has a longer time course than sporadic CJD. Between six and ten cases
are seen each year in the UK. The clinical features of genetic CJD are variable, even within
affected families. Some patients exhibit clinical features that resemble sporadic CJD, while
others present with ataxia and other movement disorders before the onset of dementia. A
blood test to exclude genetic CJD is available for those at risk of the disease.
Owner: Infection Prevention and Control Team
Version 6.1
Page 52 of 104
Review: December 2014
Iatrogenic CJD (very rare)
Iatrogenic CJD occurs through accidental transmission of infection (from patients who later
were found to have sporadic CJD, who donated the following contaminated substances for
medical or surgical procedures)
human dura mater grafts,
human pituitary growth hormone
corneal grafts
Previously contaminated instruments used in neurosurgery.
The clinical features of this diverse group of patients are partially dependant on the route of
transmission.
C. Variant CJD (vCJD)
Variant CJD was first reported in 1996 and is thought to be caused by dietary exposure to the
BSE agent found in infected cattle, although no one knows the exact route of infection. It
typically affects younger people with a median onset age in the late 20s, and symptoms differ
from those of sporadic CJD in that they are often psychiatric at onset, such as anxiety and
depression, and there may be persistent pain, with odd sensations in the face and limbs.
These are followed by more obvious neurological symptoms and progressive dementia.
Variant CJD also differs from other human TSEs in that the transmissible agent is detected
outside the nervous system, as well as inside, especially in the lymphoid tissues throughout
the body. Variant CJD has a relatively longer time course than most other forms of CJD, with
an average period of 14 months between the onset of symptoms and death.
Up to April 2007, 165 cases of vCJD have occurred in the UK (159 of whom have died). Only a
small number in other countries, 6 in France, 1 in Ireland, 1 in Italy and 1 in USA . It is thought
that the UK epidemic may have reached a peak and the latest estimates have been revised
downwards from some of the pessimistic forecasts that were made in the mid-1990s. (only 5
deaths in the UK 2005). However no one knows how many people will be diagnosed with this
disease in the future.
Transmission of vCJD
Prion diseases are transmissible in certain circumstances, but they are not infectious in the
usual ways. They are not spread by respiratory droplets, direct skin contact or sexual contact,
nor is there evidence of mother-to-child transmission.
The cause of CJD is thought to be an abnormal form of the naturally occurring prion protein
(PrP) that can be infectious. In its normal form, designated as PrPc, this protein occurs in the
brain and other parts of the body in humans and a wide range of animals; it function is
unknown. The abnormal prion protein, designated as PrPsc, is chemically identical to the
normal form but its physical shape is different, making it resistant to normal cell degradation. It
is thought to build up by inducing normal protein to misfold, although how this change occurs is
unknown. These changes lead to accumulation in various tissues, with the highest levels
occurring in the central nervous system where tissue damage is most severe. As the disease
progresses there is loss of neuronal tissue which gives rise to the characteristic ‘spongiform’
appearance of the brain.
Owner: Infection Prevention and Control Team
Version 6.1
Page 53 of 104
Review: December 2014
In vCJD the consumption of BSE-contaminated beef or other bovine-derived products remains
the most likely means by which vCJD was acquired, and to which most of the UK population
would have been exposed.
There is the possibility of on going person-to-person spread. There have been 4 cases of
transfusion associated vCJD infection acquired from blood received from donors who later
were found to be infected with vCJD. Since April 2004 people who have received a blood
transfusion in the UK since 1980 are no longer able to donate blood
Since 2004 all patients with bleeding disorders who have been treated with UK sourced,
pooled factor concentrates or antithrombin, between 1980 and 2001, have been classified as
“at risk” for vCJD for public health purposes This is because it is possible that a plasma
donation from a donor, who may subsequently develop vCJD , may have contributed to the
plasma pool used for the manufacture of the clotting factor concentrates. They have been
informed that they have an additional risk of acquiring vCJD but a low chance of its
development. They have been informed to:
Do not donate blood, organs, tissues, sperm, eggs or breast milk
To tell all treating persons e.g. surgical, endoscopy, dental, so special arrangements
can be put in place for the instruments used, if necessary.
To inform family (family not at any additional risk)
Clinical care should not be compromised in any way.
Action to take in general practice
If you are notified that a patient has been identified as ‘at risk’ of acquiring vCJD you must take
the following action:
Ensure patient has received and understood the Information for patients leaflet. The
patient should have already received this from their care centre e.g. haemophilic centre.
If not, it can be downloaded from the website detailed under further information at the
end of this section.
Ensure that they understand they must not donate blood, tissues or organs
They should inform all health care medical, surgical and dental staff that they have been
identified at risk.
Record the patient’s vCJD ‘at risk’ status in their primary care record.
Include this information in any referral letters should the patient require surgery or other
invasive medical procedures
Check if the patient has undergone any surgery within the past 12 months. If they have,
please liaise with the Essex Health Protection Unit (0845 1550069) in order to ascertain
whether any further action needs to be taken. In addition, please inform the Director of
Public Health for North East Essex
Owner: Infection Prevention and Control Team
Version 6.1
Page 54 of 104
Review: December 2014
Guidance for dentistry
Patients considered ‘at risk’ of vCJD for public health purposes should inform their dentists
about this. This will enable the dentist to ensure satisfactory standards of infection control are
used. Dentists may also include the information in referrals to specialists such as maxillofacial
surgeons.
Further Information
HPA website: www.hpa.org.uk
6.8
New Entrants/Migrants to the UK and Infectious Diseases
For information please refer to the HPA website: www.hpa.org.uk
6.9
Pregnancy and Infectious Diseases
Please also refer to New & Expectant mothers policy ACE237.
Early in the antenatal stage of pregnancy (or when you are aware that a women is planning a
pregnancy), it is helpful to gain information about their immune status. It is therefore
suggested that antibodies against Rubella, Parvovirus and Chicken Pox be checked.
If a pregnant women presents at the GP surgery with questions about recent contact with
cases of infectious diseases or presents with a rash, urgent advice should be sought from a
medical microbiologist.
Colchester General Hospital
01206 747474
The HPA document ‘Guidance on the management of rash illness and exposure to rash in
pregnancy’ contains detailed information and can be accessed from: www.hpa.org.uk/infections/topics az/pregnancy/rashes/default.htm
Owner: Infection Prevention and Control Team
Version 6.1
Page 55 of 104
Review: December 2014
SECTION 7 – CLINICAL PRACTICE
The purpose of this document is to ensure all staff understands their responsibilities on the
prevention & control of infection in relation to specific clinical practices.
The Clinical Practices included in the section are:
7.1
Information on Antibiotic Prescribing Formularies in North East Essex
7.2
Aseptic Non Touch Technique – please also refer to the Aseptic Non Touch Technique
Clinical Policy ACE368 - Principles of best practice for clinical procedures
7.3
Barrier nursing (isolation of patients) – Please also refer to Guidelines for the Control of
outbreaks and infection including surveillance and notification Clinical Policy ACE314 and Section
6 of these guidelines
7.4
Decontamination of Equipment including disinfectant – Please also refer to the
Decontamination Policy and Procedure Clinical Policy ACE673 and Medical Devices Policy Clinical
Policy ACE183.
7.5
Environmental Cleaning (including Legionella control) – Please also refer to the
Decontamination Policy Clinical Policy ACE367 or Legionella Policy Clinical Policy ACE296
7.6
Enteral Feeding and Infection Prevention and Control
7.7
Intravenous Therapy and Infection Prevention and Control
7.8
Urinary Catheters and Infection Prevention and Control
7.9
Management of non infectious deceased clients
7.10
Minor Surgical procedures undertaken by ACE staff
7.11
Laundry Management (including staff and patient clothing)
7.12
Safe Handling of Specimens
7.13
Vaccine Control and mass vaccination sessions
7.14
Waste Management – Please also refer to the Clinical Waste Policy ACE295
Owner: Infection Prevention and Control Team
Version 6.1
Page 56 of 104
Review: December 2014
7.1.
Information on Antibiotic Prescribing Formularies in North East Essex
Appropriate and prudent antibiotic prescribing is vital for the management of good infection
control practice.
There are antibiotic prescribing formularies that are available for staff to follow in North East
Essex. Staff must ensure that they have an appropriate copy and must adhere to all the
information it contains.
Primary Care and GP Led services
Management of infection guidance for Primary Care for consultation and
local adaption
Antibiotic regimes for the elderly.
Available on http://www.neessexccg.nhs.uk/Library/Prescribing%20Information.html
Then click on BNF infections
Also available:
-
Colchester Hospital University Foundation Trust acute antibiotic regimes.
Copies are available from the Infection Prevention and Control Team.
7.2.
Aseptic Technique
Please refer to Clinical Policy ACE368 Aseptic Non Touch Technique. Principles of best
practice for clinical procedures
7.3
Isolation of Patients (Barrier Nursing)
Please also refer to:
The “Guidelines for the Control of Outbreaks of infection including surveillance and
notification procedures for infectious diseases”, Clinical Policy ACE314. These
guidelines also includes associated posters regarding isolation precautions and
cleaning
Section 6, of these guidelines: ‘Management of Infectious Diseases’.
Introduction
Isolation is the use of infection control practices aimed at controlling the spread and
eradication of pathogenic organisms. These practices may require the setting up of
mechanical barriers to contain pathogenic organisms within a specified area.
It should be recognised that staff caring for clients in their own homes do not have to fully
implement the traditionally recognised methods of barrier nursing. This is because there
are generally no other vulnerable patients who need to be protected from cross infection,
Owner: Infection Prevention and Control Team
Version 6.1
Page 57 of 104
Review: December 2014
apart from staff and other people who live in the house, for whom the practice of standard
precautions will suffice.
Barrier nursing includes:
Source isolation to segregate infected patients in single rooms to prevent the spread
of infection
Cohort source isolation to segregate a number of patients with the same infection in
one ward, when there are inadequate number of single rooms (should have
designated staff for this area)
Protective isolation (reverse barrier nursing) to segregate immunosuppressed
patients to protect them from acquiring an exogenous infection
Strict source isolation to segregate patients with a serious contagious disease e.g.
viral haemorrhagic fever, in isolation units to prevent the spread of infection
The decision to isolate a patient will be influenced by the availability of suitable facilities and
the infectious nature and the immune status of the patients. A risk assessment to evaluate
the risk of cross infection to other patients must be performed to ensure the most
appropriate restrictions are implemented. The procedures implemented must be adhered to
universally by all staff entering and leaving isolation facilities.
The patient and all visitors, require detailed information on all the procedures required
If a patient in in-patient units, is suspected/known to have an infectious disease, appropriate
barrier nursing procedures must be put in place immediately. Contact the Infection Control
Team as soon as aware of a suspected or known infectious disease.
General Guidance for Isolation
Hand Hygiene
Alcohol hand rub should be used after normal hand washing with liquid soap.
In addition to washing hands at standard times e.g. after handling body fluids, before
performing an invasive procedure, etc. hands should be washed before leaving the side
room.
Disposal of Potentially Infected Items
Contaminated dressings and all disposable items should be disposed of as clinical waste.
There should be a clinical waste bag in the room, which when full is then double-bagged
into another clean clinical waste bag, just outside the room and then taken directly to the
clinical waste awaiting collection site.
Community setting: A designated collection from the client’s home will be necessary for
patients with a known infection. For details see the policy for the Management of Clinical
waste
Urinal and Bedpans
Disposable urinals and bedpans inserts should be used with commodes. A plastic apron
and non-sterile vinyl gloves should be worn. Used urinals and bedpans should be
bagged/covered and taken directly to the sluice for immediate disposal into a macerator.
Where patients are nursed in bed and a bedpan holder is used with a disposable bedpan
Owner: Infection Prevention and Control Team
Version 6.1
Page 58 of 104
Review: December 2014
inserted, ensure the holder is thoroughly cleaned following use with Chlor-clean solution –(1
tablet in 1 litre of cold water) They should be dried and returned to the isolation room
ready for next use.
When caring for a patient in his/her own home; contents should be emptied down the toilet.
The urinal or bedpan should then be cleaned with General Purpose Detergent and hot
water prior to disinfection with a sodium hypochlorite solution (strength 10,000 ppm – 1 part
household bleach to 10 parts water) and left for 10 minutes. The bedpan/urinal should be
dried and stored inverted in the patients’ room for their sole use.
Accidental spills must be dealt with immediately (see spillage management section)
Linen
Advise patients in isolation to wear hospital clothing where possible, so they can be
laundered in an approved laundry.
A linen bag should be taken into the patient’s room and removed immediately after use.
Guidance on procedures and bags should be provided by the approved site laundry service
and this guidance must be followed
The current policy for in-patient units infected and soiled linen should be placed in red
soluble alginate bags in the room and then double bagged into a red linen bag and taken to
be stored with the other used linen awaiting collection.
If visitors take clothing home advise to wash on as hot a wash as the fabric will allow. Dry
thoroughly, (tumble drier is recommended) and iron with a hot iron if possible to heat
disinfect. Heavily soiled/infected items may need disposal in clinical waste.
Bathing
An infected patient must be bathed last on the ward. The bath must be cleaned and dried
after the previous patient and after the infected patient with GPD followed by a chlorine
containing disinfectant. All areas including the floor must be cleaned after use.
Dressings
Aseptic non touch technique must be used for all dressings. Used lotions, creams etc.
should be stored in the room and not used for other patients
Crockery and Cutlery
Disposable items are not required. Use of a dishwasher is recommended but otherwise
general-purpose detergent and water as hot as can be tolerated is sufficient. (Wearing
domestic rubber gloves)
Cleaning the Room
Domestic staff must understand why barrier nursing is required and should be instructed on
the correct procedures. The area where barrier nursing is being carried out should be
cleaned last and separate cleaning equipment must be kept for this area. This should be
disposable or laundered after use, to ensure it is not inadvertently used elsewhere.
Domestic staff must wear disposable gloves and yellow (or red) aprons and discard them
Owner: Infection Prevention and Control Team
Version 6.1
Page 59 of 104
Review: December 2014
before leaving the room. They must then wash their hands leave the room and close the
door behind them and use alcohol hand rub.
All cleaning should be performed using general purpose detergent and water, and then
wiping over the pre-cleaned surfaces with a 1,000 ppm chlorine releasing solution e.g. HazTabs or Presept which must be made up to manufacturers guidance, or a one step cleaning
and chlorine releasing disinfectant may be used e.g. Chlorclean.
The floor must be cleaned daily and dried. After use the mop head must be removed and
disposed or bagged and laundered in a hot wash. After use the bucket must be carefully
emptied in the domestic sluice/hopper, cleaned and dried. The used mop head should not
be placed in the bucket of water. The mop handle must also be cleaned and dried after
each use.
All furniture and fittings should be damp dusted using a disposable cloth daily. The cloth
must be disposed of in the clinical waste bin in the room after use
The toilet/commode must be cleaned at least daily with a non-abrasive cleaner/ GPD. If
soiled a chlorine releasing solution wipe should be used after pre-cleaning with GPD. (Or
use ChlorClean, combined GPD and chlorine releasing solution.)
Transporting clients with infections outside the source isolation area
Clients should only be sent to other department/premises (i.e. care homes, hospital outpatients or other in-patient departments) when it is essential. Staff involved in the direct
care of the client should be informed of the risk in advance, so that the relevant control
measures can be implemented in the areas visited. If possible arrange for the patient to
have the last appointment of the day.
Deceased Clients
If the client had, or was suspected of having, an infectious disease when they died, the
body is likely to need to be placed in a body bag (see section 7.9).
Body bags are available from the funeral director on request.
The funeral Director staff should be informed of the potential infectious risk.
Discharging the Patient
Ensure the patient has all the information they require on any requirements they or their
visitors may need at home.
Cleaning the room
Wearing gloves and disposable apron:
o Enter room and open windows
o The room should be stripped.
o All textiles including curtains must be placed in appropriate bags and sent to the
laundry as “infected” laundry.
Owner: Infection Prevention and Control Team
Version 6.1
Page 60 of 104
Review: December 2014
o Any equipment must be disposed, or thoroughly cleaned and dried.
o Nothing should be taken out of the room unless it has been cleaned.
o In general, cleaning with GPD and wiping with a chlorine releasing solution is all that
is required.(or use Chlorclean or Chlor-Clean)
o Disposable cloths must be used and mop heads disposed of or laundered in a hot
wash
o Impervious surfaces e.g. lockers, stools etc should be washed as above and dried
o Spot clean walls before general cleaning. Start cleaning of high surfaces and work
down.
o Floor must be washed and dried
o On completion of cleaning, remove plastic apron and dispose in yellow bag
o Dispose of disposable gloves or wash and remove rubber gloves.
o Leave with the cleaning equipment.
o Wash hands
o Clean and dry cleaning equipment
o Remove waste and linen bags to collection area
o Wash hands
o Return to cubicle and replenish paper towels, bags, liquid soap, toilet rolls etc and
rehang curtains
o Inform staff that all procedures have been completed and that the room is ready
Cohort Isolation
If there are insufficient side rooms for patients all suffering from the same infectious
disease, then these patients may be nursed in an area together.
The same principles apply as above with strict observance of all standard precautions
including hand hygiene, use of protective clothing and stringent cleaning. Staff should be
designated to work in that area and not in other areas of the ward. There must not be any
admissions to the ward whilst cohort nursing of infections is in place. Admissions to the
ward should only occur after all infected patients are clear of infection or been discharged
and the area thoroughly cleaned as above.
Protective Isolation
Protective isolation is a process of care, which provides a safe environment for patients
who are susceptible to infection by isolating them as far as possible from all exogenous
sources.
Indications
Immunosuppression caused by:
Leukaemia, lymphoma, AIDS, drugs in particular, cytotoxics and cortico-steroids. Irradiation
therapy etc.
As care of these patients is rare in Primary Care community hospital bed areas, please
contact the Infection Prevention Control Team for more information if required. A poster is
also available for side rooms doors setting out the key messages and actions required
(available in all ward areas or contact the infection Prevention and Control Team).
Owner: Infection Prevention and Control Team
Version 6.1
Page 61 of 104
Review: December 2014
7.4.
DECONTAMINATION OF EQUIPMENT including disinfection
Please refer to Decontamination Policy and Procedure ACE673. This includes:
The National Specifications for Cleaning
Minimal cleaning frequencies by risk category
A-Z Directory of Equipment methods of cleaning and responsibilities
Service pathway through EBME
Declaration of Contamination Status
Associated policy: Medical Devices Policy, Clinical Policy ACE 183.
EQUIPMENT FOR HOME LOAN
o All equipment for use in patients own home must be clean and fit for the purpose
intended. Equipment should be ordered from the Essex Equipment service, who will
arrange delivery to the patients’ home. All written instructions on use and
decontamination, if necessary in the home, should be explained and left with the
patient.
o When equipment is no longer required it should be collected by the home loan store.
Small items should be placed in plastic bags.
o The equipment store should decontaminate the equipment and either store it until
required or deliver it to satellite stores until local delivery is required.
o Community staff should not be encouraged to collect large items of used equipment
from the home and transport in their own vehicles. Any small items should be
bagged and cleaned according to the A-Z Directory of equipment methods for
cleaning and responsibilities
Community Hospitals
Mattresses must be checked weekly – Unzip mattress and inspect its inside surface and the
mattress core for staining or contamination/turn mattress. Mattress checking is recorded in
the record of cleaning books.
If mattress covers are damaged, body or other fluids can pass through and contaminate the
inner core. There is the potential for cross-infection if contaminated mattresses remain in
use.
Safely dispose of contaminated static mattresses as clinical waste.
Airwaves: arrange for collection for off site/ repair decontamination as appropriate.
Patients own home
Owner: Infection Prevention and Control Team
Version 6.1
Page 62 of 104
Review: December 2014
Simcare and airwave mattress
Following use /or if mattress becomes damaged or torn collection / replacement must be
arranged from the patients house for off site decontamination/repair
.
7.5 ENVIRONMENTAL CLEANING
Please also refer to the Decontamination Policy and Procedure ACE 367
The environment plays a role in the transmission of infection; dust, dirt and liquid residues
will increase the infection risk. They should be kept to a minimum by regular cleaning and
by good design features in buildings, fittings and fixtures. In addition cleanliness is
important for aesthetic reasons and to maintain the confidence of patients and visitors. The
Health and Social Care Act 08 and National initiatives all promote the importance of
cleanliness in the healthcare environment, to assist in tackling the problem of health care
acquired infections. These Include:
Towards cleaner hospitals and lower rates of infection (2004)
The Matrons Charter (2004)
NHS Estates Healthcare Facilities Cleaning Manual (2004)
National Specifications for Cleanliness in the NHS: a framework for setting and
measuring performance outcomes, April 2007, National Patient Safety Agency
Specification for the planning, application and measurement of cleanliness services
in hospitals (BSI 2011)
The Revised Healthcare Cleaning Manual (June 09) NPSA
Cleaning Schedules
A written cleaning schedule should be devised, specifying the persons responsible for
cleaning, the frequency of cleaning, methods to be used and the expected outcomes:
Work surfaces and floors should be smooth-finished, intact, durable of good quality,
washable and should not allow pooling of liquids and be impervious to fluids.
All surfaces should be kept clear of unnecessary equipment or clutter to ensure
regular and thorough cleaning can occur. The most important component of an
effective cleaning programme is the regular removal of dust from all horizontal
surfaces. Either by the use of a vacuum cleaner with filters or a dust control mop.
General purpose detergent and water should be used for all environmental cleaning
– follow the manufacturer’s instructions. Disinfectant such as a chlorine releasing
solution, should only be used to decontaminate spills of body fluids, or for “terminal”
cleaning of an area after a known case or outbreak of infection
Carpets are not recommended in treatment rooms or areas where clinical
procedures will take place because of the risk of body fluid spills. If present in other
areas they should be vacuumed daily and a contract in place for regular steam
cleaning and for additional cleaning when contaminated with spills.
Walls require spot cleaning to remove splashes/marks
Difficult to reach/clean areas should have contracts arranged for regular planned
preventive maintenance and cleaning e.g. behind radiator guards, fans, ventilation
units/grills etc
Owner: Infection Prevention and Control Team
Version 6.1
Page 63 of 104
Review: December 2014
All cleaning equipment should be colour coded for different areas of use, as per
National colour coding guide (see below). E.g. buckets, mop handles, aprons, gloves
and disposable cloths etc.
The water used for cleaning, in buckets, must be changed frequently and disposed in
a sluice sink/hopper. Clean the mop handle and bucket after use. Dry and store
bucket inverted.
Mop heads should be removed after each use or if become heavily soiled, for
laundering in a hot wash and then stored dry. Single use mop heads should be used
if laundering facilities are not available.
Single use, non-shedding cloths or paper roll should be used for cleaning and drying.
Equipment and materials used for general cleaning should be kept separate from
those used for dealing with body fluids.
All equipment used for cleaning including vacuums and floor polishers should be
clean and maintained properly
Responsibility
In essence it is everyone’s responsibility to ensure that the environment, where care is
given for our patients, (on our own premises) is safe and clean.
The manager of the premise has over-riding local responsibility to ensure all staff carrying
out their relevant duties to this end.
Generally it will be that domestic staff are responsible for the day-to-day maintenance of a
clean environment, following the agreed cleaning schedules.
Clinical staff are responsible for dealing with spillages of body fluids and then liaising with
domestic staff to undertake ‘spot’ cleaning as required.
Clinical staff are responsible to ensure all patient equipment is clean. Clinical staff are also
responsible for maintaining clean and tidy cupboards and shelves in areas such as clean
stores, treatment rooms and dirty utility.
Owner: Infection Prevention and Control Team
Version 6.1
Page 64 of 104
Review: December 2014
National colour coding scheme
for hospital cleaning materials and equipment
All NHS organisations should adopt the colour code below for cleaning materials. All
cleaning items, for example, cloths (re-usable and disposable), mops, buckets, aprons and
gloves, should be colour coded. This also includes those items used to clean catering
departments.
NB: It is important to ensure that there
is the clean to dirty flow (e.g. basins
are cleaned before toilets)
RED
BLUE
BATHROOMS, WASHROOMS,
SHOWERS, TOILETS, BASINS AND
BATHROOM FLOORS
GENERAL AREAS INCLUDING
WARDS, DEPARTMENTS, OFFICES
AND BASINS IN PUBLIC AREAS
GREEN
YELLOW
CATERING DEPARTMENTS, WARD
KITCHEN AREAS AND PATIENT
FOOD SERVICE AT WARD LEVEL
ISOLATION AREAS
WE GIVE ACKNOWLEDGEMENT TO THE NPSA FOR THIS POSTER. WE HAVE ADDED
SOME TEXT TO THE RED BOX TO ASSIST WITH CLARITY
Owner: Infection Prevention and Control Team
Version 6.1
Page 65 of 104
Review: December 2014
A micro-fibre system may be used for environmental cleaning following the
manufacturers recommendations. However care must be taken in older
buildings, as poor surfaces may damage the micro-fibres.
GPD = General purpose detergent
Chlorine releasing solution = Sodium Dishloroisocyanurate (NaD cc) e.g. Presept, HazTabs
1000 ppm available chlorine is recommended for environmental disinfection after cleaning
with GPD or use a combined detergent and chlorine disinfection e.g. Chlor-clean or
Chlorclean. (Blood spillage use NaD cc granule or solution at 10000 ppm av cl)
Always follow manufacturers recommendations on dilution and use.
Legionella Control
For full details please refer to the Legionella Policy ACE 296.
Legionella pneumophila is commonly found in natural sources of water and in water supply
systems. Under some conditions it multiplies and can be transmitted by aerosol spread and
infection acquired by inhalation of the legionella in these small water droplets. The risk from
legionella infection can be minimized by treatment of the water system e.g. by chlorination
of the water supply, cleaning of the system, prevention of stagnation in pipework and
ensuring water is kept at temperatures at which the organism can not multiply. Legionella
cannot be spread from person to person.
Good estates and housekeeping management of all plumbing is essential. Estates
staff should receive training in Legionella control and all staff should be aware of the
procedures required in their area of work
Managers with responsibility for buildings must ensure they know where all water
outlets are in their building, know whether it is used daily, weekly or monthly. If it is
used less than weekly, someone must be designated to flush weekly. If it is used
less than monthly, it should be questioned whether the outlet should be removed and
the appropriate arrangements made with Estates. (The attached pro-forma can be
used to assist the manager in carrying out this responsibility).
All taps, showers, toilets that are not used daily should be flushed/ran for at
least 5 minutes every week.
All unused outlets should be removed so that there are no ‘dead legs’ in the
system.
Bathrooms should not be used for storage of equipment.
Owner: Infection Prevention and Control Team
Version 6.1
Page 66 of 104
Review: December 2014
7.6
ENTERAL FEEDING and INFECTION PREVENTION AND CONTROL
This section focuses on best practice for reducing the risk of infection associated with
enteral feeding and does not replace the procedure for this clinical skill. Staff should be
appropriately trained and competent in any stated procedure or care process. Please
Contact the Clinical Development Team for details
Please also refer to the ‘essential steps’ care bundle in Appendix 7 which provides an audit
tool to support best practice in reducing the risk of infection associated with peripheral
cannula insertion and ongoing care.
Feeding via a nasogastric tube or percutaneous endoscopic gastrostomy (PEG) is used as
an alternative when patients are unable to maintain adequate nutrition orally. There are
significant microbiological hazards associated with it, which may result in gastroenteritis,
septicaemia and /or pneumonia.
The liquid nutrients and administration systems may be easily contaminated and provide an
ideal medium in which bacteria can grow. Strict application of all infection prevention and
control standards are required including the use of a aseptic non-touch technique when
assembling the administration sets and handling the feed.
Staff, patients and their carers should be educated and trained in the techniques of hand
decontamination, enteral feeding and the management of the administration system
Effective hand decontamination must be carried out before starting feed preparation (using
the correct hand hygiene technique and according to the ‘5 moments of hand hygiene
(WHO 2009)’ before starting / after any manipulation of the enteral feeding system and
following the care given..
Personal Protective Equipment should be worn (gloves and disposable apron) . PPE
must be disposed of immediately and appropriately after use.
Minimal handling and aseptic non-touch technique is used when connecting & flushing
enteral feeding tubes
Preparation and Storage of Feeds
Wherever possible pre-packed, ready to use feeds should be used in preference to
feeds requiring decanting, reconstitution or dilution.
Feed is checked to ensure it is within expiry date and that packaging is not damaged
Feeds should be stored according to the manufacturer’s instructions and, where applicable,
food hygiene legislation.
When decanting, reconstituting or diluting feeds, a clean working area should be prepared
and equipment dedicated for enteral feed use only should be used.
Owner: Infection Prevention and Control Team
Version 6.1
Page 67 of 104
Review: December 2014
Where ready to use feeds are not available, feeds may be prepared in advance, stored in a
refrigerator, and used within 24 hours.
Feeds should be mixed using cooled boiled water or freshly opened sterile water and a notouch technique.
The system selected should require minimal handling to assemble, and be compatible with
the patient’s enteral feeding tube.
Additions to sterile feeding containers are made only when there is no alternative and
following an initial risk assessment
Administration of Feeds
Minimal handling and an aseptic non touch technique should be used to connect the
administration system to the enteral feeding tube.
Ready to use feeds may be given for a whole administration session, up to a maximum of
24 hours.
Reconstituted feeds should be administrated over a maximum 4-hour period.
Administration sets and feed containers are for single use and must be discarded after each
feeding session.
Do not re-use single-use items.
Hospital setting syringes used to flush or administer drugs are used once (single use
only) and then discarded.
Community setting only where single patient-use syringes are used to flush or
administer drugs: the packaging is checked to ensure it is single patient-use and
manufacturer’s instructions are followed on use, decontamination between uses and
storage
Single patient use equipment is stored clean and dry in a lidded container marked
with the patients name as appropriate (care homes)
Care of Insertion Site and Enteral Feeding Tube
Sterile stoma dressing techniques are carried out for the first 3 days after initial placement.
After 3 days (if the site is uncomplicated) the stoma is washed daily with a clean cloth & fresh
clean water /dried thoroughly.
Dressings are used if the gastrostomy site is discharging or the patient chooses to have
them.
To prevent blockage, the enteral feeding tube should be flushed before and after feeding or
administering medications.
Owner: Infection Prevention and Control Team
Version 6.1
Page 68 of 104
Review: December 2014
Hospital setting Sterile water is used to flush enteral feeding tubes.
Community setting Freshly drawn tap water is used to flush enteral feeding tubes.
Cooled boiled tap water is used to flush enteral feeding tubes for patients fed via the
jejunum or immunocompromised patients
Where used, sterile water bottles are dated when opened and discarded in line with
manufactures instructions
Hospital setting/ care homes: Line should be labelled, dated and signed and
documented in patient records
References
DOH high impact intervention enteral feeding care bundle (updated July 10), NICE
guidance, prevention of healthcare associated infection in Primary and Community care
2003. Updated summary 31st January 2011.
World Health Organisation (2009) Hand Hygiene: Why, How & When?
7.7
INTRAVENOUS THERAPY- INFECTION PREVENTION AND CONTROL
This section focuses on best practice for reducing the risk of infection associated with
intravenous therapy and does not replace the procedure for this clinical skill. Staff should be
appropriately trained and competent in any stated procedure or care process. Please
contact the Clinical Development Team for details
Please refer to the ‘essential steps’ care bundle in Appendix 6 and 7 which provides an
audit tool to support best practice in reducing the risk of infection associated with
peripheral cannula insertion and ongoing care
Always follow the manufacturer’s recommendations for all devices. Please also refer to the
following policies and guidelines as appropriate:
The organisation presently adopts the Royal Marsden Manual of Clinical Nursing
procedures, seventh edition 2008 for the clinical procedure for the administration of
continuous, intermittent and ‘bolus’ / ‘push’ intravenous therapy.
Clinical Policy ACE275, Policy for Peripheral Vascular Devices and Intravenous Therapy
(Adult)
Clinical Policy ACE22, Management of Central Venous Access Devices (CVAD) and
Midlines
Clinical Policy ACE21, Blood Transfusion Policy and Procedure for requesting, collecting
and administration of blood/blood products to adults.
Clinical Policy ACE 507, Intravenous antibiotics in the domiciliary setting
Owner: Infection Prevention and Control Team
Version 6.1
Page 69 of 104
Review: December 2014
Clinical Policy ACE45, Management of Needlestick and Sharps Injury
Aseptic Non Touch Technique. Principles of best practice for clinical procedures ACE368
A vascular access device (VAD) is a device that is inserted into either a vein or an artery,
via the peripheral or central veins to provide for diagnostic (e.g. blood sampling), or
therapeutic (administration of medication, fluids, blood etc). There are many different types
of VADs available and information for their insertion and management should be followed
according to the manufacturers instructions of use. Central venous access devices (CVAD)
are inserted for longer term access e.g. for; cytotoxic therapy, repeated transfusion or
parenteral nutrition
Peripheral intravenous cannula insertion is a commonly performed procedure, however has
an associated risk of infection because of the potential for direct microbial entry to the
bloodstream. Intravenous cannulae may be contaminated by the patient’s skin flora at the
insertion site, or by the introduction of other organisms via the cannula hub or injection port
Infection control and safety
Use of aseptic non touch technique, observation of universal precautions and product
sterility are required in infusion procedures.
Gloves should be used when performing infusion procedures
Effective hand decontamination must be carried out (using the correct hand hygiene
technique and according to the ‘5 moments of hand hygiene (WHO 2009)
All disposable blood-contaminated and/or sharp items including, but not limited to needles
must be disposed of in non permeable, puncture resistant, tamper proof containers which
complies with BS7320 standards and should be located at a suitable and safe level in
places which are not accessible to the public.
All precautions must be taken to prevent needlestick injury.
All patients should have a patient record that documents the reason for VAD placement,
type of device, insertion site, type of catheter, date and time replaced, the name of the
person placing the device, problems encountered during insertion, the care required and
the condition / appearance using standardised assessment scales for phlebitis and / or
extravasation.
Healthcare workers and patients need to be educated and trained and assessed as
competent, in the care of VAD. Before discharge, patients and their carers should be taught
any techniques required, and how to manage their device. The community nursing service
should continue to support the patient at home according to the instructions from the
discharging hospital/manufacturers instructions
Owner: Infection Prevention and Control Team
Version 6.1
Page 70 of 104
Review: December 2014
Contamination
There are two types of contamination, intrinsic and extrinsic.
Intrinsic contamination may be due to:
Faulty manufacturing of a product.
Poor transport.
.
Poor storage.
Inappropriate use of
equipment
To prevent infection from intrinsic sources, solutions must be inspected prior to use:
Checking that packaging is intact and in date.
Inspecting contents of containers bags and vials for discoloration, punctures, haziness
and particles.
Checking the expiry date of the fluid / drugs.
Extrinsic contamination
Extrinsic contamination occurs at any point during the insertion, use or removal of the
access device. There are three main routes by which organisms may gain entry to the
infusion device / catheter / system, namely:
Extraluminal, whereby micro-organisms gain access via the outside of the device,
through the insertion site.
Intraluminal, involving the introduction of micro-organisms into the device, giving set or
IV fluids.
Haematogenous seeding, whereby micro-organisms from other sites in the patient’s
body are transferred by the blood flow to the device.
Asepsis
A strict aseptic non-touch technique (ANTT) must be applied and hands decontaminated
thoroughly before and after the procedure. Gloves should be worn when performing
infusion related procedures:
For insertion of peripheral lines
Whenever the insertion site is exposed
Whenever the intravenous system is accessed, manipulated or broken e.g. drug
administration, changing administration sets, changing solution bags / bottles, taking
blood samples.
Central venous access devices (CVAD) should be inserted as a surgical procedure in a
designated area using maximal sterile barrier precautions. The correct position of the tip
must be checked by x-ray examination, before any infusion is given.
NB FOR CARE AND MANAGEMENT OF CENTRAL VENOUS ACCESS DEVICES
PLEASE REFER TO ACE CLINICAL GUIDELINES ACE22 Management of Central
Venous Access Devices (CVAD) and Midlines
Owner: Infection Prevention and Control Team
Version 6.1
Page 71 of 104
Review: December 2014
Four principles of vascular access devices care :
Regardless of the type of VAD used the key principles of care remain the same
a).‘To prevent infection’ Dougherty and Lister (2008 p856)
In selecting an appropriate insertion site, assess the risks for infection against the risks
of mechanical complications.
A peripheral cannula should be removed every 72hours, or sooner if any complications
are suspected. Record the date of insertion and removal in the patient’s notes.
A peripheral cannula inserted in an emergency situation where aseptic technique has
been compromised should be replaced within 24hours (RCN 2010 p 35).
Assess the need for continuing venous access on a regular basis and remove as soon
as clinically possible in order to reduce the risk of infection
Aseptic technique and compliance with recommendations for equipment and dressing
changes are vital. Skin cleansing around the vascular access device insertion site prior
to insertion and between dressing changes is required. It is important to note that a
quick wipe fails to reduce bacterial counts prior to peripheral cannulation. Allowing any
cleaning solution to dry is vital in order for disinfection to be completed.
Skin decontamination (peripheral cannula)
Prior to the skin cleansing procedure ensure any patient allergy / sensitivity is
checked. Decontaminate the skin site with a single patient use application of alcoholic
chlorhexidine gluconate solution 2% chlorhexidine gluconate in 70% isopropyl alcohol
Chloraprep SEPP 0.67ml. Allow to dry for 30 seconds and do not touch the disinfected
skin surface again.
Prior to administration of infusion therapy all intravenous ports, connections, rubber
bungs and vial bungs should be cleaned thoroughly with 2% chlohexidine gluconate and
70% isopropyl alcohol (sanicloth CHG 2%) and should be allowed to air dry for 30
seconds. This is essential.
(Refer to manufacturer’s information to check compatibility of all materials used)
‘The insertion site should be checked regularly for signs of phlebitis (erythema, pain
and / or swelling) or for signs of infection. Complaints of soreness, unexpected pyrexia
and damaged, wet or soiled dressings are reasons for immediate inspection and
renewal of the dressing’. The infusion phlebitis scale should be used and the score
documented in the patients record.
Check and record:
- At least 4 hrly during continuous infusions
- When flow rates are checked or altered and solution containers changed
- At shift change during continuous or intermittent infusions
- On each intermittent or bolus infusion
Owner: Infection Prevention and Control Team
Version 6.1
Page 72 of 104
Review: December 2014
NB If a peripheral cannula is not in regular use it should be inspected and flushed with a
compatible flush usually 0.9% sodium chloride for injection. Always consider removal of
the cannula if not in regular use.
Removal of peripheral cannula should be an aseptic procedure. Remove the device using
a slow, steady movement and apply pressure until haemostasis is achieved. Pressure
should be firm and not involve rubbing. If the needle is removed carelessly a haematoma
may occur. The site must be examined to ensure bleeding has ceased and the site
covered with a sterile dressing. The cannula integrity should be inspected to ensure the
complete device has been removed, and appropriate documentation completed.
Securement of devices can be used to prevent movement, which reduces the risk of
phlebitis, infiltration, infection and migration.
‘An ideal intravenous dressing should provide an effective barrier to bacteria; allow the
device to be securely fixed; be sterile, easy to apply and remove; be waterproof and
adhere well; and finally be comfortable for the patient’.
Moisture permeable transparent dressings – allow inspection of the insertion site while the
dressing is in situ and are waterproof but also moisture permeable. Transparent dressings
should not be bandaged as the visibility and moisture permeability are obscured.
Peripheral cannula dressings should be changed every 72 hours in conjunction with the
cannula change or sooner if not intact or moisture collects under dressing.
b) To maintain a closed system with few connections to reduce risk of
contamination and disconnection.
If equipment becomes accidentally disconnected there is risk of infection, blood loss and
air embolism. Accidental disconnection poses a greater risk in patients with central
venous access devices (CVAD) than those with peripheral devices. This is because of the
amount of air that could be introduced via a CVAD and the speed with which it could enter
the pulmonary vessels.
‘Luer locks provide a more secure connection and all equipment should have these fittings
i.e. administration sets, extension sets, injection caps. Needle-free systems provide a
closed environment, which further reduces the risk of air entry.’
Cited: Dougherty and Lister 2008 (p 857)
c) ‘To maintain a patent device.
‘Maintaining patency can be achieved by either a continuous infusion keeping the vein open
or intermittent flushing after each use with appropriate solution according to ACE’s policy.’
‘Blockage predisposes to device damage, infection, inconvenience to patients and
disruption to drug delivery. Occlusion of the device is usually the result of:
‘Clot formation due to:
Owner: Infection Prevention and Control Team
Version 6.1
Page 73 of 104
Review: December 2014
‘An administration set or electronic infusion device being turned off accidentally and left
for a prolonged period or insufficient or incorrect flushing of the device when not in use’.
‘Precipitate formation due to inadequate flushing between incompatible medications’.
Cited: Dougherty and Lister 2008 (p 858)
Excessive force should never be used when flushing any device.
It is necessary to always perform adequate flushing between administration of each drug to
avoid incompatibilities from occurring RCN (2010 p12)
The cannula site must be inspected prior to the administration of any medications/ infusions
and four hourly during continuous infusion to assess patency. If a peripheral cannula is not
in regular use it should be inspected and flushed with 0.9% sodium chloride for injection
daily.
However always consider removal of the cannula if not in regular use.
d) ‘To prevent damage to the device and associated intravenous equipment’
Preparation of medication
Within inpatient settings drugs should be prepared in a clinical room that is clutter free,
ensuring that the surface or trolley has been adequately cleaned. Where possible, a
designated work surface must be kept for the preparation of drugs.
‘The nurse should have a thorough knowledge of the principles of reconstituting, including,
but not limited to aseptic technique, compatibility (physical, chemical and therapeutic)
stability, storage, labeling, interactions, dosage and calculations and appropriate
equipment’ RCN (2010 p12 )
‘A registered pharmacist should be consulted on issues of compatibility’. RCN (2010 p12)
‘Aseptic technique should be used throughout reconstitution. This includes adequate
cleaning of additive ports of infusion bags and the tops of medicine vials and ampoules’.
RCN (2010 p12)
It is important to ensure the drug is prepared aseptically and safely, checking the container
and drug for faults, using the correct diluent and only preparing immediately prior to
administration. Dougherty and Lister 2008
Owner: Infection Prevention and Control Team
Version 6.1
Page 74 of 104
Review: December 2014
Expiry dates should be verified prior to initiation or administration of therapy, and proper
storage of medication according to manufacturers guidelines must be ensured, to make
certain there is validity of the expiry date RCN (2010 p12).
‘Compatibility between medications and delivery systems shall be ascertained prior to the
administration of prescribed infusion medications’ RCN (2010 p12).
Needle-free devices
In-line filters should not be used routinely for infection control purposes
Antibiotic lock solutions should not be used routinely to prevent catheter-related
bloodstream infections
Do not routinely administer intranasal or systemic antimicrobials before insertion or
during the use of a central venous access device to prevent catheter colonisation or
blood stream infection
Systemic anticoagulants should not be used routinely to prevent catheter-related
bloodstream infections
The introduction of new intravascular devices that include needle-free devices
should be monitored for an increase in the occurrence of device associated infection
(report to MHRA)
Follow manufacturer’s recommendations for needle-free devices including
instructions for use, changing and for ensuring all components are compatible.
(Training and user instructions are available via the Clinical Development Team).
When using needle-free devices decontaminate the access port before and after use
as described previously.
Prior to accessing needle free devices / intravascular connectors and following use
of the device, ensure that the top/septum of the connector is in its closed/home
position. (There is a risk of infection if the top/septum of the connector remains
recessed within its housing. Swabbing of the connector in this condition may lead to
inadequate decontamination. If the top/septum remains recessed, replace the
connector and report as an incident according to ACE’s policy MHRA (2008).
Administration Sets and IV fluids
Examine all intravenous fluid bags and drugs for administration for dates of expiry
and evidence of damage or contamination. Also check fluid against prescribed
medication chart.
‘Administration sets should be changed according to use (intermittent / continuous
therapy), type of device and type of solution, and the set must be labelled with the
date and time of change’. (Cited in Dougherty and Lister 2008 p 217)
Replace all tubing when the vascular device is replaced’. (Cited in Dougherty and
Lister 2008 p 217)
Replace administration sets for solutions in continuous use, at 72 hours unless
become disconnected earlier.
Administration sets for blood and blood components should be changed when the
transfusion episode is complete or every 12 hours (whichever is the sooner)
Owner: Infection Prevention and Control Team
Version 6.1
Page 75 of 104
Review: December 2014
Administration sets used for parenteral nutrition should be changed every 24 hours
or immediately upon suspected contamination or when the integrity of the product or
system has been compromised. However if the solution contains only glucose and
amino acids, administration sets in continuous use, do not need to be replaced more
frequently than every 72 hours RCN (2010 p24)
All solution sets used for intermittent infusions e.g. antibiotics, should be discarded
immediately after use and not allowed to hang for reuse. (Cited in Dougherty and
Lister 2008 p 218).
A compatible flush, usually 0.9% sodium chloride for injection may be used to flush
the drug through the tubing but the risk to patients on restricted intake should be
considered.
All medical equipment for example drip stands etc must be cleaned both routinely
and following patient use RCN (2010 p13).
RECOGNISING VENOUS ACCESS DEVICE ASSOCIATED INFECTIONS
Localised effects may occur at the insertion site or along the track of a tunnelled device.
These include:
Thrombophlebitis
Exudate formation
Heat at site
Oedema
Pain
Irritation
Erythema
Systemic effects include:
Pyrexia
White cell count elevated
ACTION TO TAKE IN THE EVENT OF AN INFECTION OCCURRING
Do not inject via the catheter or use the intravenous line
Contact the Doctor in charge of the patient’s care – an alternative route or site of
administration should be considered (cannula should be removed at first indication of local
infection)
Take swab for Microbiology culture and sensitivity
Consider taking blood cultures
Mid-stream specimen of urine (MSU) chest x-ray, throat swabs
Owner: Infection Prevention and Control Team
Version 6.1
Page 76 of 104
Review: December 2014
Patient information
Patient education is extremely important. Patients should receive adequate information
about the early signs of phlebitis, i.e. pain, redness and swelling and what to do if there is
accidental dislodgement or removal of the cannula. They must also know where to seek
help.
With central venous access devices patients should have instruction on signs and
symptoms to look out for and when and who to contact. The patients should be told to
report signs of redness or tracking at the exit site or up the arm, any oozing at the exit site
and fevers or rigors. Also to report immediately pain and/ or swelling over the shoulder,
across the chest / into the neck and arm.
All instructions given to patients should be recorded in the patient’s notes
References
DOH high impact interventions peripheral intravenous cannula insertion and ongoing care
actions (updated July 10),
Pratt et al (2007) epic 2 National Evidence based guidelines for preventing healthcare
acquired infection in NHS hospitals in England, Marsden Manual of Clinical Nursing
procedures (2008) and the RCN Standards for Infusion Therapy 2010.
World Health Organisation (2009) Hand Hygiene: Why, How & When?
7.8
URINARY CATHETERS AND PREVENTION AND CONTROL OF INFECTION
This section is written specifically about the infection prevention and control aspects of
urinary catheter care and does not replace the procedure for this clinical skill. Staff should
be appropriately trained and competent in any stated procedure or care process. Please
contact the Clinical Development Team for details
Please see the Policy for Male and Female Catheterisation (For Nurses Working in
Adult Services). (ACE52)
Please also refer to the ‘essential steps’ care bundle in Appendix 4 & 5 which provides an
audit tool to support best practice in reducing the risk of infection associated with urinary
catheter insertion and ongoing care
Urinary catheters are inserted to provide urinary drainage. They may be introduced via the
urethra or into the bladder through a supra pubic procedure.
Healthcare workers must be trained and competent in
The consideration of alternatives methods of management where possible
The decision to catheterise
Urinary catheter insertion
Ongoing care and maintenance.
Owner: Infection Prevention and Control Team
Version 6.1
Page 77 of 104
Review: December 2014
Patients and relatives should be educated about their role in preventing urinary tract
infection, the management of the urinary drainage system and, when and how to seek help.
Comprehensive information, advice and support is available from continence advisors.
Catheter associated urinary tract infection (CAUTI) is the most common hospital acquired
infection. The presence of a urinary catheter, and the duration of its insertion are
contributory factors to the development of a urinary tract infection. Some 60% of
healthcare-associated urinary tract infections are related to catheter insertion. The financial
cost of urinary infection has been estimated at £1,222 per patient.
Bacteria may enter the bladder of the catheterised patient in one of four ways:
introduced with the catheter at the time of insertion
travel along the outside of the catheter
travel along the inside of the lumen of the catheter
through a break in the closed system
These bacteria quickly develop into colonies known as biofilms, which adhere to the
catheter surface and drainage bag. This can result in the bacteria having an increased
resistance to antibiotic therapy and crystallization of calcium resulting in encrustation of the
catheter, over a period of time.
Catheterising patients places them in significant risk of acquiring a urinary tract infection.
The longer the catheter is in place, the greater the risk.
Only use indwelling urethral catheters after considering all alternative methods of
management
Document the need for catheterisation, date of insertion, batch number, size (complete
the sticky label) and the care required, and sign with a clearly legible signature.
Document the follow up plan e.g. trial without catheter (when and who), referral to
urology
Review regularly the patient’s clinical need for continuing catheterisation and remove as
soon as possible
Assessment for Catheter Equipment
Once the decision to insert a urinary catheter has been made an individual assessment
needs to be completed by the nurse or continence advisor for:
Size, length and material type of catheter
Appropriate drainage and securing system
Manufacturers guidelines must always be followed.
Choice of catheter material will depend on patient assessment and anticipated duration
of catheterisation
Select the smallest gauge catheter that will allow free urinary outflow. A 10ml balloon
should be used in adults. Urological patients may require larger gauge and balloons
Owner: Infection Prevention and Control Team
Version 6.1
Page 78 of 104
Review: December 2014
The retaining balloon should be filled with sterile water to the volume indicated by the
manufacturer (usually 10mls) or may be pre-filled.
Insertion
The organisation presently adopts the Royal Marsden Manual of Clinical Nursing
procedures, seventh edition (2008) for the clinical procedure for catheterisation
Catheterisation is an aseptic non touch technique procedure. Healthcare workers
(HCW) must be trained and competent to perform the procedure.
Ensure the urinary catheterisation record/catheter passport is completed for each
patient. This is available within the Policy for Male and Female Catheterisation ACE53.
Catheter Maintenance
Maintaining a sterile, closed urinary drainage system is central to the prevention of
infection of CAUTI (Catheter Associated Urinary Tract Infection)
Typical equipment consists of: catheter, leg bag and night bag or catheter valve (e.g. flip
flow).
The leg bag, attached to the end of the catheter should remain in place according to the
manufacturers recommendation. This should be for up to 7 days or changed earlier if
damaged. Should it be removed or become detached for any reason before that, then a
new sterile bag is required.
To provide the client with a greater capacity of drainage a night bag can be attached to
the end of the leg bag. It is recommended that single use, non–drainable, night
bags should be used.
Non-drainable bags should be emptied as indicated by the manufacturer.
Leave the Closed System Alone!
Connect indwelling urinary catheters to a sterile closed urinary drainage system
Ensure the connection between the catheter and the drainage system is not broken
except for good clinical reasons e.g. changing bag in line with manufacturers
recommendation.
Decontaminate hands and wear a new pair of clean non-sterile gloves before
manipulating a patient’s catheter and decontaminate hands after removing gloves
Obtain urine sample from a sampling port using an aseptic technique
Position urinary drainage bags below the level of the bladder. Secure leg bag with
straps as recommended by manufacturer. Always use a stand that prevents contact
with the floor for night bags.
Owner: Infection Prevention and Control Team
Version 6.1
Page 79 of 104
Review: December 2014
Empty drainage bag frequently enough to maintain urine flow and prevent reflux. Use
a separate and clean container for each patient and avoid contact between the
urinary drainage tap and the container. Use disposable containers. Empty urine in
the toilet or sluice.
Do not add antiseptic or antimicrobial solutions into urinary drainage bags
Try to identify a pattern of catheter life and changes should be planned accordingly
Routine daily personal hygiene is all that is needed to maintain meatal hygiene.
Soap and water washing or bathing or showering is all that is required (women clean
from front to back). The use of lotions, talc etc. should be avoided
Bladder irrigation, instillation or washouts should not be used to prevent catheter
associated infection
Antibiotic prophylaxis when changing catheters should only be considered for
patients with a history of persistent CAUTI following catheter change.
If an infection is suspected (presence of pyrexia, groin pain, offensive smelling and cloudy
urine), a specimen of urine should be taken from the sampling port using an aseptic
technique and ideally bacteria should identified before antibiotics are commenced. However
if clinical symptoms would treat
Supra pubic urinary catheters require the same assessment and drainage procedures. A
sterile dressing will be necessary until the entry/exit site heals and then normal
washing/bathing may resume.
To remove an indwelling urinary catheter the retaining balloon must be deflated using a
syringe.
It is essential that no part of the catheter be cut prior to removal.
References
Pratt et al (2007) epic2: National Evidenced Guidelines for Preventing HealthcareAssociated Infections in NHS Hospitals in England. DOH high impact interventions urinary
catheter insertion and continuing care actions (updated July 10). World Health Organisation
(2009) Hand Hygiene: Why, How & When?
7.9
MANAGEMENT OF NON-INFECTIOUS AND INFECTIOUS DECEASED CLIENTS
Please also refer to the “Last Offices”, Clinical Policy ACE20.
Introduction
This guideline sets out the procedures for staff to follow for the management of noninfectious and infectious deceased clients.
Management of Deceased Clients
Owner: Infection Prevention and Control Team
Version 6.1
Page 80 of 104
Review: December 2014
The deceased should be treated with the due respect and dignity appropriate to their
religious and cultural background. Last offices, which vary according to religious and
cultural practices, may be compromised by the need for specific measures if an infectious
disease was associated with the death, or co-existed at the time of death.
Most bodies are not infectious, however through the natural process of decomposition the
body may become a source of potential infection whether previously infected or not,
therefore sensible precautions should be taken routinely.
a. Disposable gloves and aprons should be worn when washing and preparing the
body
b. Washing the body with soap and water is adequate.
c. Dressing, drainage tubes, etc. should be removed unless the death occurred within
24 hours of an operation or was unexpected in which case a post mortem is likely.
d. Clean dressings should be applied to any wounds.
Additional Last Offices for a known Infected Body
The body of a person who has been suffering from an infectious disease may remain
infectious to those who handle it.
Body bags are available from either the undertaker or the stores centre where all other care
equipment is requested from. Please see guidelines for handling cadavers in table 1 and 2
on the next pages to determine if the body needs to be placed in a cadaver bag. Other
situations in which a body bag should be used are also listed.
The mortuary/funeral director staff should be informed of the potential infectious risk.
Where safety allows, all religious beliefs of the deceased and their relatives must be
respected.
Once the body is sealed in the body bag, protective clothing will no longer be necessary.
Relatives and friends who wish to view the body should do so as soon after death as
possible. A member of staff wearing gloves and plastic apron can open the bag, but
relatives should be told there is a risk of infection and should be advised to refrain from
kissing or hugging the body. In some rare instances the bag could not be opened e.g. if the
patient suffered form Anthrax, Plague, Rabies and Viral Haemorrhagic Fever.
Table 1: Guidelines for handling cadavers with infections notifiable in England and Wales
Degree of risk
Low
Infection
Bagging
Viewing
Hygienic
preparation
Embalming
Acute encephalitis
No
Yes
Yes
Yes
Leprosy
No
Yes
Yes
Yes
Measles
No
Yes
Yes
Yes
Meningitis (except meningococcal)
No
Yes
Yes
Yes
Mumps
No
Yes
Yes
Yes
Ophthalmia neonatorum
No
Yes
Yes
Yes
Owner: Infection Prevention and Control Team
Version 6.1
Page 81 of 104
Review: December 2014
Medium
Rubella
No
Yes
Yes
Yes
Tetanus
No
Yes
Yes
Yes
Whooping cough
No
Yes
Yes
Yes
Relapsing fever
Adv
Yes
Yes
Yes
Food poisoning
Adv/No
Yes
Yes
Yes
Hepatitis A
No
Yes
Yes
Yes
Acute poliomyelitis
No
Yes
Yes *
Yes
Diphtheria
Adv
Yes
Yes
Yes
Dysentery
Adv
Yes
Yes
Yes
Leptospirosis (Weil's disease)
No
Yes
Yes
Yes
Malaria
No
Yes
Yes*
Yes
Meningococcal septicaemia
Adv
Yes
Yes
Yes
Paratyphoid fever
(with or without meningitis)
Adv
Yes
Yes
Yes
Cholera
No
Yes
Yes *
Yes
Scarlet fever
Adv
Yes
Yes
Yes
Tuberculosis
Adv
Yes
Yes
Yes
Typhoid fever
Adv
Yes
Yes
Yes
Typhus
Adv
No
No
No
High
Hepatitis B,C, and non-A non-B
Yes
Yes
No
No
High (rare)
Anthrax
Adv
No
No
No
Plague
Yes
No
No
No
Rabies
Yes
No
No
No
Smallpox
Yes
No
No
No
Viral haemorrhagic fever
Yes
No
No
No
Yellow fever
Yes
No
No
No
Adv = Advisable and may be required by local health regulations.
*Requires particular care during embalming.
Definitions:
Bagging: placing the body in a plastic body bag.
Viewing: allowing the bereaved to see, touch, and spend time with the body before disposal.
Embalming: injecting chemical preservatives into the body to slow the process of decay. Cosmetic work may be included.
Hygienic preparation: cleaning and tidying the body so it presents a suitable appearance for viewing (an alternative to embalming).
Table 2: Guidelines for handling cadavers with some infections that are not notifiable in
England and Wales
Chickenpox/shingles
No
Yes
Yes
Hygienic
preparation
Yes
Cryptosporidiosis
No
Yes
Yes
Yes
Dermatophytosis
No
Yes
Yes
Yes
Legionellosis
No
Yes
Yes
Yes
Lyme disease
No
Yes
Yes
Yes
Orf
No
Yes
Yes
Yes
Psittacosis
No
Yes
Yes
Yes
Methicillin resistant Staphylococcus aureus
No
Yes
Yes
Yes
Tetanus
No
Yes
Yes
Yes
Degree of risk
Low
Infection
Bagging
Owner: Infection Prevention and Control Team
Version 6.1
Page 82 of 104
Viewing
Embalming
Review: December 2014
Medium
High
HIV/AIDS
Adv
Yes
No
No
Haemorrhagic fever with renal syndrome
No
Yes
Yes
Yes
Q fever
No
Yes
Yes
Yes
Transmissible spongiform encephalopathies
Yes
No *
No
No
Yes
No
No
No
(for example, Creutzfeldt-Jakob disease)
Invasive group A streptococcal infection
Adv = Advisable and may be required by local health regulations.
* If necropsy has been carried out. Definitions: see table 1.
Ref: Healing et al (1995).
Other situations in which a body bag should be used:
Known intravenous drug user
Severe secondary infection
Gangrenous limbs/infected amputation sites
Large pressure sores (e.g. grade 4)
Clostridium difficile if leakage present
If there are large quantities of body fluids present
Pyrexia of unknown origin
Brucellosis
Always consider the people who will be handling the body after it leaves the ward.
Document any infectious disease on the notification of death form to allow mortuary
staff to communicate this to funeral directors.
Reference list
T D Healing, P N Hoffman, S E J Young (1995) Public Health Laboratory Service
Communicable disease report vol 5 no 5 (last reviewed July 08). Accessed on HPA site
21/01/10
7.10
MINOR SURGICAL PROCEDURES UNDERTAKEN BY ACE STAFF
Introduction
Infection prevention and control is an important part of an effective risk management
programme to improve the quality of patients’ care and the occupational health of staff.
Patients undergoing invasive procedures such as minor surgery will have an increased
susceptibility to infection. There is evidence that adherence to good infection prevention
and control principles can significantly reduce the risk of infection post procedure.
The purpose of these guidelines is:
To ensure an adequate infection control programme is in place for the protection of
patients undergoing minor surgical procedures.
Owner: Infection Prevention and Control Team
Version 6.1
Page 83 of 104
Review: December 2014
To ensure practitioners involved in minor surgery are protected against infectious
hazards by maximising occupational and procedural safety.
These guidelines describe the working practices, standards and procedures that Anglian
Community Enterprise (ACE) recommends Health Care Workers to implement when
performing minor surgery.
Levels of Risk
For the purpose of the guidance minor surgical procedures are considered under two
different groups, so as to reflect the degree of risk involved the procedures become more
invasive.
Group One
Injections
Aspirations
Curette, cautery and cryo-cautery
Group Two
Incisions
Excisions
‘Lumps and Bumps’
Toenail removal
Vasectomy
Please note that there may be additional requirements for specialised procedures.
It is not recommended that endoscopy is performed in General Practices, unless a full
assessment has taken place to ensure that the environment is safe and appropriate.
Please contact the Community Infection Prevention and Control team for further
information.
Standards for Group One Procedures
Injections, Aspirations, Curette, Cautery and Cryo-cautery
These can be undertaken in a GP consultation/examination room or in the practice
treatment room as long as the room is clean and tidy. And:
All infection control standard precautions as detailed in these guidelines and as
summarized below, must also be implemented.
Standards for Group Two Minor Surgical Procedures
Incisions, excisions, ‘lumps and bumps’, toe nail removal, vasectomy
Ideally, these should be undertaken in a room designated for the purpose of minor
surgical procedures only. If this is not possible due to the constraints of the building,
please contact the Community Infection Prevention and Control Team, so that a risk
Owner: Infection Prevention and Control Team
Version 6.1
Page 84 of 104
Review: December 2014
assessment can be undertaken on your behalf and advice can be given on the individual
requirements necessary for minor surgery to be performed in the room available.
As a minimum requirement, a treatment room may be utilised, but this room must be
clean and tidy with:
washable, impervious floors, walls and ceiling
intact, washable, impervious work tops and cupboards
No clutter on any surfaces (or room can be easily cleared and cleaned prior
to minor surgery sessions)
In addition the following summaries of infection control standards must be
implemented for ALL minor surgical procedures
Aseptic non Touch Technique (ANTT)
Standard
Aseptic non touch technique must be used for all clinical procedures
Please refer to the Aseptic Non Touch Technique Policy ACE368.
The Environment
Standard - The environment is in good order and a good standard of repair, to assure
cross-infection does not take place.
The ceiling, walls and floors must be washable, in a good state of repair, and visibly
clean. Flooring should be intact with sealed joins and coved edges.
The lighting must be of a good quality, florescent tubes must be covered with diffusers.
Examination lamps must be correctly designed so as to ensure they give enough light
and that the bulb is encased within the lamp casing.
There must be sufficient storage space, to ensure that there is no clutter on the surfaces.
The cupboards and worktops must be in a good state of repair, orderly and clean inside
and out.
The couch covering must be washable and in good repair. No linen should be used and
the disposable paper towelling must be changed between patients.
Couch curtains should be laundered regularly (4 monthly, in a commercial laundry), or
straight away if contaminated. A record of cleaning evidencing laundering should be
maintained. Disposable curtains are also available
Vertical blinds are recommended if required at windows. The windows and ledges must
be clean and dust free and not used for storage. Blinds should be cleaned/wipeable.
A designated stainless steel, free standing dressing trolley which is in a good state of
repair and which can be cleaned with sani-cloth CHG 70% isopropyl alcohol and 2%
chlorhexidine individual wipes between use.
Owner: Infection Prevention and Control Team
Version 6.1
Page 85 of 104
Review: December 2014
Hand Hygiene
Standard - To minimise the risk of cross-infection, all staff have access to hand cleansing
facilities and use the correct hand hygiene technique according to the ‘5 moments of hand
hygiene (WHO 2009).
There must be a designated hand-wash sink, with elbow/wrist/mixer taps.
Access to the hand basin should be clear.
The sink should be visibly clean
Wall dispensed liquid soap should be available from a cartridge style dispenser
Thorough hand decontamination must be undertaken prior to performing minor surgery
(please refer to the Hand Hygiene policy and procedure ACE 273)
Wall dispensed paper towels for hand-drying should be available
Only single-use nailbrushes should be used.
Protective Clothing
Standard - The health care worker demonstrates the appropriate usage of protective
clothing.
Single-use disposable aprons should be worn as exposure to body fluids is possible.
Should it be should be worn as likely exposure to blood /body fluids
Single use gloves must be worn as it is likely there will be exposure to blood/body
fluids. Please refer to the Aseptic non touch technique policy ACE368 regarding
glove risk assessment and use of sterile/non sterile gloves.
A pair of plastic goggles/face visor should be available in the surgery for use when
excessive splashing of body fluids to the face is anticipated.
Decontamination
Standard - Local decontamination and sterilisation of instruments is now not permissible in
General Practice or ACE premises
In order to be able to perform minor surgery, sterile instruments must either be
sourced from a single-use equipment supplier, or via a Sterile Services Department.
All equipment should be rotated to ensure products are used within expiry times
Single-use equipment
Single use items must never be re-used.
Sterile products should be stored above floor level in cupboards.
Owner: Infection Prevention and Control Team
Version 6.1
Page 86 of 104
Review: December 2014
All sterile products (including cautery tips equipment) must be single-use,
All single use, disposable equipment must be disposed of immediately after use as
per manufacturer’s instructions; Therefore a sharps container that conforms to
BS7320 and a yellow clinical waste bag supported in a foot operated, rigid bin must
be available.
Sterile equipment obtained from Sterile Services Department (SSD):
Stock rotation must be implemented to ensure products are used within expiry times
Sterile packs and all equipment should be stored in cupboards
Used equipment should be stored separately in a designated safe area prior to
collection within a 7 day period
Spillages
Standard The health care worker will demonstrate safe handling and disposal of all body
fluids.
Staff should be familiar with the policy for dealing with spills of body fluids (refer to
section 2).
All equipment required for dealing with spillages, including a Sodium Hypochlorite
solution should be readily available for use.
Specimens
Standard - All specimens are collected, labelled, and transported safely to prevent the risk
of contamination or infection.
Specimens must be collected using universal precautions.
Specimens must be well secured and placed in a re-sealable clear plastic bag.
Specimens must be clearly labelled, on both the specimen container and the
accompanying form.
Specimens should be stored in a separate designated area while awaiting collection.
Specimens should be transferred to the laboratory, under controlled circumstances.
Waste Disposal
Standard - All waste from health care premises is segregated and identified at source,
transported and disposed of safely without risk of contamination, infection or injury to health
care staff and the general public.
There should be correct segregation of glass, clinical and household waste, and the
correct colour coded bags must be used.
Waste bags should be no more than 2/3rds full, then sealed and labelled.
Owner: Infection Prevention and Control Team
Version 6.1
Page 87 of 104
Review: December 2014
Foot operated and rigid sided bins should be available and be clean inside and out.
There should be a designated area to store all waste prior to collection, which is kept
secure from unauthorised persons, entry by animals and free from infestations.
All waste should be collected on a regular weekly basis by an approved waste contractor
Handling of Sharps
Standard - All sharps will be handled and disposed of safely from the point of use to the site
of incineration to prevent the risk of sharps injury.
Sharps containers used should conform to BS7320 and be assembled and labelled
correctly.
They should be stored bracketed to the wall.
They should be available at the point of use, when any clinical procedure including the
use of sharps is in process.
The boxes should be less than 2/3rds full and with no protruding sharps. They should
then be closed and sealed and stored in a designated area whilst awaiting collection by
the approved waste contractor.
Staff should all be aware of what action should be taken following a sharps injury.
Guidelines, Policies and Standards
Standard - There are written policies and procedures that demonstrate infection prevention
and control for all patient/client care.
The infection prevention and control guidelines are easily accessible to all staff (see
page 6 for details of all relevant policies and procedures.
All staff are asked to read and implement the guidelines.
Clinical staff who have contact with blood, should be vaccinated against Hepatitis B,
and there should be documented proof of this and of proof of immunity acquired via
the post vaccination antibody blood test (please refer to section 5 and contact
Occupational Health for details.
All staff who perform “exposure prone procedures” EPPs i.e. those invasive
procedures where there is a risk that injury to the worker may result in the exposure
of the patient’s open tissues to the blood of the worker, need to be aware of their
obligations to declare it if they know themselves to have been at risk of exposure to a
blood borne virus infection (hepatitis B, C or HIV)
All staff should ensure that they are familiar with and understand the statements by their
professional bodies.
Owner: Infection Prevention and Control Team
Version 6.1
Page 88 of 104
Review: December 2014
7.11
LAUNDRY MANAGEMENT
Introduction
This guidance is split into two sections; one for health centres, clinics, day centres and
general medical practices, the second for community hospital.
Health Centres, Clinics, Day Centres and General Medical Practices
It is strongly recommended that linen is not used.
Couches
The surface of all couches must be of a washable impermeable fabric.
The condition of the surface of all couches should be regularly checked (minimum
once monthly) to ensure the fabric remains intact.
The couch should be covered with disposable paper towel, which must be changed
between patients.
If the paper towel becomes soiled and the soiling seeps through to the surface of the couch,
the couch must be decontaminated before use by another patient. General-purpose
detergent and warm water or GPD hard surface wipes is sufficient to decontaminate the
surface of the couch. If contaminated with blood, clean with a sodium dichloroisocyanurate
compound (e.g. Acticlor, Haz-tabs, Presept, Sanichlor) following manufacturers instructions
followed by cleaning with general-purpose detergent and warm water.
Changed to Pillows are not considered essential, as all couches should have head-tilts.
However, if pillows are used, they should be sealed within a plastic impermeable
cover and covered with paper towel as on couch.
Blankets/sheets are not considered essential. For modesty, a double length of
disposable paper towel should be used to cover exposed parts of the body.
Curtains
At windows, it is recommended that washable blinds are used.
Around couches, curtains should only be used if required to protect patient’s
modesty.
There should be an environmental cleaning schedule, which should include blinds
and bed curtains to be washed twice yearly or straight away if soiled. An industrial
washing machine/laundry should be used, not a domestic washing machine
Disposable curtains are available if no washing facility available.
(www.marlux-medical.co.uk)
Owner: Infection Prevention and Control Team
Version 6.1
Page 89 of 104
Review: December 2014
Terry Towels
There is no place for terry towels in healthcare practice. Hands should be dried on
paper towels.
To protect the patient whilst performing ear syringing paper towels should be used.
In-patient units
General Advice for Handling Used Linen
Staff must wear vinyl gloves and plastic aprons when handling used linen.
The linen ‘billie’ should be taken to the area where used linen is handled, to prevent
staff from walking round with used linen. Linen should be sorted and placed in
appropriate colour bags, according to the instructions issued by the laundry contract
management
Hands must be washed once protective clothing is removed.
Once the appropriate bag is ¾ full, it must be securely tied.
The secured bag should be removed directly from the ward environment to the
designated area to await collection. This area should be away from public areas,
and stored off the ground.
Filled linen bags should be removed from the local collection area by portering staff
on at least a daily basis to the main collection area
Infected Used Linen
The process is the same as above, except that:
When the used, tied bag is ready to be taken from the barrier nursing room (or other
area), it must be put directly into a second linen bag at the door way.
Soiled or infected linen should be placed in a red, soluble, alginate bag and then this bag
placed in a red linen bag.
Industrial Washing Machines and Driers
Domestic machines must not be used in health care areas. Industrial machines may be
used as long as they are used, maintained and serviced according to the manufacturer’s
instructions.
Staff dealing with laundry should be trained. Protective clothing i.e. gloves and aprons must
be used and hands washed, after removal of protective clothing in a hand wash sink in the
laundry room. There must be a clear workflow so contaminated and clean linen cannot
come into contact. Clean gloves and apron must be used for each load, dirty and clean.
The washed linen must be dried straight away in an industrial drier. This must be vented
Owner: Infection Prevention and Control Team
Version 6.1
Page 90 of 104
Review: December 2014
externally and filters checked and changed as recommended. Clean linen must not be
stored in the laundry room.
The room must be kept clear, clean and dust free.
Washing processes should include a heat disinfection cycle where the temperature should
be maintained at 65 degree C for not less than 10 minutes or preferably 71 degrees C for
not less than 3 minutes.
Disinfection is possible with chemicals, for example hypochlorites, at low temperatures
although performance is often restricted by the presence of soiling, or detergents in the
wash. It may be possible to achieve disinfection by adding sodium hypochlorite to the
penultimate rinse. (Hypochlorites should not be used with materials treated for fire
resistance)
STAFF UNIFORMS OR WORK CLOTHES
Staff uniforms must be fit for the purpose and clean. Managers must ensure that all staff
have sufficient uniforms for a clean uniform to be worn each day of duty.
Ideally, staff should arrive at and leave work in their own clothes, changing into and out of
their uniform at work. When changing facilities are not provided staff should change as
soon as home is reached.
Clothes that become contaminated with body fluids must be changed at the first opportunity
to avoid the spread of infection
Under no circumstances should staff go out socialising/shopping in clothes that may have
been in contact with body fluids.
Uniforms or work clothes should be washed as soon as possible on as hot a wash, as the
fabric will tolerate. (65 degrees C is recommended for thermal disinfection but most
domestic machines only wash at 60 degrees C and most clothes have a label
recommending washing at 40 degree C) Cardigans/jumpers should be washed at least
weekly and not worn when giving clinical care.
Uniforms should not be washed with newborn baby, elderly persons or immunocompromised persons clothing.
Worn uniforms should be stored away from other household washing whilst awaiting
washing.
The majority of bacteria and viruses will not survive away from the host and would not
present a high risk of infection on clothing. However, within a mass of body fluid,
organisms would survive longer.
Shoes should be cleaned immediately if contaminated with body fluids, using general
purpose detergent and hot water – disposable gloves should be worn.
If uniform/clothing is heavily contaminated with body fluids, it should be disposed as clinical
waste and a new uniform issued.
Owner: Infection Prevention and Control Team
Version 6.1
Page 91 of 104
Review: December 2014
Advice to carers taking linen home to launder (from hospital) or laundering in
patients own home
The basic elements of standard infection control precautions should be explained and
followed by patients and carers in the community in relation to laundry. In particular the use
of protective clothing such as gloves and aprons and the importance of hand washing
should be emphasised. In addition the following should be noted:
Dispose of plastic bags used to carry items
Launder at as high a temperature as possible as per washing instructions
Use normal washing powder
Tumble dry where possible
Iron with a hot wash where possible
Wash hands after dealing with soiled items and after removing gloves
Hand washing/rinsing of used linen is not recommended, but if absolutely necessary
submerge items to avoid aerosolisation and splashes. Do not leave items in soak or
add disinfectants
Generally personal items do not need to be separated for washing
Heavily soiled items; dispose of any solids in toilet, place in washing machine and
use sluice/prewash cycle before washing in main wash cycle on as hot a wash as
the fabric will allow. If items are heavily soiled, disposal by wrapping well and placing
in waste is recommended
7.12
SAFE HANDLING OF SPECIMENS
Introduction
Clinical specimens include any substance, solid or liquid, removed from the patient for the
purpose of analysis.
Staff should be trained to handle specimens safely.
General Principles
All specimens should be collected using standard precautions (i.e. wearing of appropriate
gloves, disposable plastic apron and washing and drying of hands before and after the
procedure).
In general the more material sent for examination the greater the chance of isolating
significant bacteria. Never use a swab when faeces, fluids or pus is available
Specimens should be collected before the commencement of antibiotic therapy or if not
possible ensure details regarding the antibiotics are included on the pathology form that
accompanies the specimen.
When a patient is asked to provide a specimen, they should be provided with the
appropriate container and given instructions as to how to collect the specimen.
Owner: Infection Prevention and Control Team
Version 6.1
Page 92 of 104
Review: December 2014
Swabs should be placed in the appropriate transport medium. The laboratory will provide
information on which media to use. Special viral transport medium (VTM) is available for
use for the culture and isolation of viruses e.g. influenza.
Swabs from dry areas should be moistened with sterile transport medium before swabbing
the area
Specimens are readily contaminated by poor technique
Urine specimens; wash genital area with soap and water before collection. Male retract
foreskin, women separate labia if possible.
Catheter specimens of urine: Only collect from the sampling port. Thoroughly clean the port
using a Sani-Cloth CHG 2% single use wipe or steret. Obtain the sample using a
needlefree syringe and aseptic non touch technique. Do not take the specimen from the
bag or by breaking system.
Faeces: may be examined for bacteria, viruses, ova, cysts, parasite and toxins. 5-10 mls is
sufficient. Take sample with spatula from mucoid or blood stained areas if present. Solid
stools will not be processed.
If the outside of a specimen container is contaminated with body fluids this should not be
wiped and then sent to the laboratory but should be discarded and another specimen
collected. The same applies if a container leaks after collection. This is to protect all staff
who may come into contact with the contaminated container. Specimens from patients
known to have bloodborne virus infections must be labeled “High Risk”. However all
specimens must be treated by all staff as a risk of infection
Laboratory approved specimen containers must be labelled with the patient identification
details, the date, and the type of specimen. The lid should be screwed on tightly after
deposit of the specimen in the container. The specimen container must then be placed in
an individual transparent plastic transport bag as soon as it has been labelled and then the
bag section sealed.
The microbiology request form must always accompany the specimen and should be put
inside the envelope section of the specimen bag as soon as all details have been
completed.
Details required: patient name and identification number, date of birth, If a wound swab,
state the type of wound, where on the body it was taken from, whether wound is deep or
superficial and if antibiotics have been used either topically or systemically, the tests
required and the provisional diagnosis, pyrexia if present, the requesting doctor details and
any requests regarding copies that need to be sent on to other professionals as appropriate
e.g. GP.
Other information to be considered that may be relevant and enable the laboratory to
consider further tests include:

Recent travel abroad
Owner: Infection Prevention and Control Team
Version 6.1
Page 93 of 104
Review: December 2014



Immunosuppression e.g. radiotherapy, cytotoxics etc.
Occupation e.g. farming, animals, industry,
Sports e.g. caving, water sports, hiking, camping
Specimens must be sent to the laboratory as soon as possible after collection. Whilst
awaiting transport, specimens should be stored securely for as short a time as possible i.e.
not overnight and away from food and medicines.
The laboratory must receive sputum specimens within 24 hours.
NB
In the event of a suspected outbreak of infection it is important for specimens
to be collected promptly and for the request form to be marked as ‘possible
outbreak’. Stool specimens should be sent as soon as an outbreak is suspected e.g.
the second loose stool. The laboratory should be alerted to expect specimens from
a possible outbreak situation.
Contact the laboratory with any queries regarding specimen collection or for advice
regarding safety.
7.13
VACCINE CONTROL AND MASS VACCINATION SESSIONS
Introduction
Vaccines are biological products that need to be stored under controlled conditions to
maintain their potency and efficacy. The aim of vaccination is to induce a specific immune
response against a particular microorganism without causing the actual disease.
Storage
On arrival, vaccines should be checked to ensure the cold chain has not been broken and
for signs of damage or leakage.
A nominated person, who has received specific training, should make sure the vaccines are
signed for on delivery, handled correctly and immediately stored in a vaccine fridge, which
is designed for this purpose and not used for any other purpose.
Ensure strict stock rotation with new vaccines being placed behind older stock.
Discard expired vaccines safely.
Prevent over stocking and allow air to circulate around all stock.
Do not store in fridge door or in separate drawers in the bottom of the fridge as air cannot
circulate. (Vaccine fridges should not have these separate areas for storage)
Ensure systems are in place to prevent accidental disconnection of the electricity.
Do not store items other than vaccines in the same fridge.
Owner: Infection Prevention and Control Team
Version 6.1
Page 94 of 104
Review: December 2014
Defrost and clean regularly, storing vaccines in an alternative fridge during procedure.
Temperature Control
Vaccines must be kept between 2ºC and 8ºC during transportation, delivery and storage.
If ice packs are used during transportation then the vaccines must not directly touch the ice
packs. A maximum/minimum thermometer should be used in each transport pack and
temperatures checked to be within the required range and recorded whenever pack
opened. Advice must be sought from the manufacturer regarding the length of time that
vaccines are allowed to be out of the cold chain and still used and after how long they
should be discarded.
Each vaccine fridge should have an internal temperature probe fitted with an external
monitor for reading the temperature, without opening the door. This temperature must be
recorded daily and any discrepancies to the normal range must be reported to the senior
clinician immediately. A logbook should be maintained of all the recordings and all service
and maintenance reports regarding the vaccine fridge.
Administration
Use reconstituted vaccine according to the manufacturer’s recommendations, usually within
one to four hours.
Remove vaccines from the fridge for the minimum length of time before administration –
discard any opened in error.
Do not prepare vaccine in advance of immunisation as this increases the risk of
administering the wrong vaccine and may affect the temperature control. Prepare each
vaccine for the individual who is to receive it.
Do not routinely cleanse the skin prior to vaccination unless it is visible dirty. If alcohol or
other antiseptics are used to cleanse the skin then they must be completely dry before
vaccine is administered, otherwise live vaccines may be inactivated.
Multi-dose vials may be used for one session only – discard any remaining at the end of the
session.
Record all details of vaccination given in the records including the name of the vaccine, the
batch number, date of expiry, administration site and the name of the vaccinator and the
date.
Mass Vaccination Sessions e.g. at schools
All of the above guidance must be followed i.e. correct temperature, transport, storage,
handling and administration of all vaccines. It must be ensured that the container used for
the storage of the vaccines is capable of keeping the vaccines at the correct temperature
Owner: Infection Prevention and Control Team
Version 6.1
Page 95 of 104
Review: December 2014
for the duration of each session required. Guidance should be sought from the
manufacturer whether any unused vaccine at the end of each session, kept at the required
temperature, may be returned to stock or whether it should be disposed. Any vaccine
allowed to be returned to stock must be labeled with the date and time kept out of controlled
storage and must be used first in the next session. It must never be taken out and returned
to storage more than once.
In addition consideration must be given to the use of appropriate rooms and premises for
mass vaccination sessions. These guidelines address the infection control issues regarding
vaccination sessions but there are many other health and safety needs, which need to be
taken into consideration.






The area must be clean and tidy with adequate space for each vaccinating
healthcare worker (HCW) and all the equipment
There should be easy access to good hand washing facilities with running hot and
cold water, liquid soap and disposable paper towels for hand drying.
In addition alcohol hand rub should be available at each vaccination area for use by
the HCW for use as a hand disinfectant if the hands are not soiled. If hands become
soiled e.g. with blood or vaccine they should be washed immediately with soap and
water. Detergent hand wipes may be used in between each vaccination followed by
the application of alcohol rub.
A correctly assembled, labeled and used sharps box must be available at each
vaccination area
Protective clothing such as disposable gloves and aprons must be available.
Equipment for the management of blood and body fluid spills must also be available
(See spillage management section of guidelines)
Owner: Infection Prevention and Control Team
Version 6.1
Page 96 of 104
Review: December 2014
7.14
WASTE MANAGEMENT
This section has been updated. Please refer to the “Clinical Waste Policy”, ACE295.
Owner: Infection Prevention and Control Team
Version 6.1
Page 97 of 104
Review: December 2014
SECTION 8 – VACCINATIONS
The purpose of this document is to inform staff of where they can access up-to-date
information on vaccinations.
8.1.
Advice on Childhood Immunisations
Information on all immunisation against infectious diseases including childhood
immunisations is available from the Department of Health’s reference manual,
“Immunisation against Infectious Disease” 2006, available from the TSO; telephone
0870 600 5522 (Updated November 2011).
The full text and updates are also available at www.dh.gov.uk/greenbook/
Useful website for patients where they can obtain additional information on the vaccines
are:
www.dh.gov.uk/en/publichealth/immunisation/index.htm
8.2.
Advice on Travel Vaccinations
Refer to www.hpa.org.uk
Owner: Infection Prevention and Control Team
Version 6.1
Page 98 of 104
Review: December 2014
APPENDIX 1
Checklist:
CARE BUNDLE FOR PREVENTING THE SPREAD OF INFECTION
Checklist:
CARE BUNDLE FOR PERIPHERAL INTRAVENOUS (IV)CANNULA: INSERTION ACTIONS
CARE BUNDLE FOR PERIPHERAL INTRAVENOUS (IV) CANNULA: ONGOING CARE
APPENDIX 2 & 3
APPENDIX 4
Checklist:
CARE BUNDLE FOR URINARY CATHETER CARE: INSERTION
APPENDIX 5
Checklist:
CARE BUNDLE FOR URINARY CATHETER CARE: CONTINUING CARE
Checklist:
CARE BUNDLE FOR CENTRAL VENOUS CATHETERS: ONGOING CARE
APPENDIX 6
APPENDIX 7
Checklist:
CARE BUNDLE FOR ENTERAL FEEDING
Page 2 of 2
Infection Prevention and Control.
Owner: Infection Prevention and Control Team
Version 6.1
Page 99 of 104
Revised: April 10. Review: April 2011
Review: December 2014
APPENDIX 8
Essential Steps (community teams, clinical inpatient areas, Jubilee unit
& minor injuries)
Compliance and reporting framework
Nominated member of staff peer
reviews colleagues practice using
essential steps care bundles
(example ‘preventing the spread of
infection’ see appendix 1-7)
Team Manager feeds back
results to team staff.
Team/ward manager submits
audit data returns to Head of
service/collator by the end of each
calendar month.
Head of service submits
data to Infection Control by
10th of each month
A feedback form is completed if
any actions were either not
performed when they were
applicable or were performed
incorrectly (see appendix 13).
Infection prevention and
control team produce overall
ACE service data for
essential steps (macro view)
and provide to:
All heads of service.
Respective Assistant
Directors, Directors and
Managing Director
Head of service present any
exception reports and
actions for discussion at the
infection Prevention and
control committee which
reports to the Governance
and risk committee
Infection control team
provide results monthly to
the Commissioners
Team /ward managers to discuss
with members of staff to who were
challenged and any training needs
identified /support given.
Compliance Standard and Actions
90 – 100%
A feedback form is required
The target for essential
steps including
hand hygiene is set at
90%, monitored
through the essential
steps audits
undertaken by peers
The respective
services overall data
between 70 – 90%
Team Leader/Manager must inform
the Head of service of any individual
that remains non compliant
The Head of service will issue a
formal verbal warning in accordance
with the Trust procedure* to the non
compliant person and keep a record
of the issue
Head of service discuss the number
of non compliances with their
assistant director/discussed at
directorate governance meeting
If the person remains non compliant
the team/ward manager must raise
this with the Head of service who
must continue to follow the Trust’s
performance management process
The respective
services overall data
falls below 70%
Any teams/wards where
actions in the essential
steps were either not
performed when applicable
or performed incorrectly to
provide a feedback form to
the Head of service
detailing actions
(supervision / training etc)
1. Any teams/wards where
actions in the essential
steps were either not
performed when applicable
or performed incorrectly to
provide a feedback form to
the Head of service
detailing actions
(supervision /training etc)
2. Teams / wards
managers to ensure
training is provided as
appropriate to the area
<70%
1. Any teams where actions
in the essential steps were
either not performed when
applicable or performed
incorrectly to provide
feedback form to the Head
of service detailing actions
(supervision /training etc).
2.Targeted training
3. Special measures will be
enacted (these can include
visits from the DIPC,
Director of Nursing or
Managing Director.)
Any team that has not submitted monthly audit
data to the head of service/collator by the due
date will be recorded as 0% compliance.
*The employee has a right
to representation if a formal
verbal warning is issued
Where unforeseen circumstances arise which prevent
essential steps audit being undertaken these must be
discussed with the Head of Service and respective
Assistant Director prior to the due submission date, and
at their discretion ‘no opportunity’ recorded by the collator
if appropriate.
APPENDIX 9
Essential steps – Feedback Form
(COMMUNITY AND CLINICAL INPATIENT AREAS)
To be completed if any actions in the essential steps checklist were either not performed when it
was applicable or were performed incorrectly. Please complete and return with the monthly essential
steps returns to the Head of service
Compliance Standard and Actions
Date:
The target for essential
steps including
hand hygiene is set at
90%, monitored
through the essential
steps audits undertaken
by peers
Time:
Team / Ward / Unit:
Tick which essential step/care bundle
feedback is being given for:

The respective services
overall data between 70 –
90%
Preventing the spread of infection
90 – 100%
A feedback form is required
Any teams/wards where actions in the
essential steps were either not
performed when applicable or
performed incorrectly to provide a
feedback form to the Head of service
detailing actions (supervision / training
etc)
1. Any teams/wards where actions in
the essential steps were either not
performed when applicable or
performed incorrectly to provide a
feedback form to the Head of service
detailing actions (supervision /training
etc)
2. Teams / wards managers to ensure
training is provided as appropriate to
the area
Urinary catheter care – insertion
Urinary catheter care – continuing care
The respective services
overall data falls below
70%
Enteral feeding
<70%
1. Any teams where actions in the
essential steps were either not
performed when applicable or
performed incorrectly to provide
feedback form to the Head of service
detailing actions (supervision /training
etc).
2.Targeted training
Central venous catheters – ongoing care
3. Special measures will be enacted
(these can include visits from the
DIPC, Director of Nursing or CEO.)
Any team that has not submitted monthly audit data to the head of
service/collator by the due date will be recorded as 0%
compliance
Peripheral Intravenous (IV) cannula – insertion
actions
Where unforeseen circumstances arise which prevent essential steps
audit being undertaken these must be discussed with the Head of
Service and respective Assistant Director prior to the due submission
date, and at their discretion ‘no opportunity’ recorded by the collator if
appropriate.
Peripheral Intravenous (IV) cannula – ongoing
care
Observer:
Detail which observation it was (e.g. Obs number
4)
Detail the actions in the essential steps checklist that were either not performed when it was applicable or
were performed incorrectly
Detail all the actions taken (include: feedback given to /any supervision / training):
Detail any further action required
Print name of person completing form:
Signature:
Date: April 2011.
Owner: Infection Prevention and Control Team
Version: 6
Page 101 of 104
Review: December 2014
Review: April 2013
APPENDIX 10
Inter-Healthcare Patient Infection Prevention & Control Transfer Form
Instructions: Complete this form on transfer or discharge from community hospitals/inpatient units. Complete whether a patient presents an infection
risk or not. This form may also be completed for patients being admitted into hospital/inpatient units from the community.
PATIENT/CLIENT DETAILS: (attach label if available)
INFECTION STATUS
Please tick most appropriate box
Patient Name:
Address
Date of birth:
NHS number:
Consultant:
GP:
No known infection – go directly to final section at bottom
Confirmed
state organism:
Suspected
state organism:
Patient/client exposed to others with an infection e.g. D&V?
If ticked state what exposed to:
Is the patient/client aware of their diagnosis / risk of infection?
Yes 
No 
Actual date discharge/ transfer /admission:
Present patient / client location:
Confirmed = those colonised or infected with organisms such as MRSA,
glycopeptide-resistant enterococci, pulmonary tuberculosis and enteric
infections including Clostridium difficile.
Suspected risks = Those who are awaiting laboratory tests to identify
infections/organisms.
Detail where the patient is being transferred / discharged or admitted to:
The need for any invasive devices has been reviewed and if still in situe on
discharge there is a clear rationale documented. Yes 
N/A 
Only complete this section if infection confirmed / suspected /or patient exposed
The receiving facility has been informed of infection status prior to transfer / discharge.  Yes  N/A
Transport informed?
 Yes  N/A
Should the patient/client require isolation, the receiving unit have been informed.
 Yes  N/A
If patient/client has diarrhoeal illness, please indicate bowel history for last week:
(frequency and type based on Bristol stool scale)
Is the diarrhoea thought to be of an infectious nature? Yes  No 
Relevant specimen results (including admission screens – MRSA, glycopeptide-resistant enterococcus SPP, C.difficile, multi-resistant
Acinetobacter SPP) and treatment information, including antimicrobial therapy:
Specimen:
Date:
Result:
Treatment information to date and any required treatment / other information /advice given to patient:
On discharge:
Patients on the MRSA pathway undergoing decolonisation can complete their MRSA topical treatment at home: Patients may take their remaining bottle of hibiscrub
home and use until finished and continue using the bactroban if in use in the nose (up to 5 days).
Final Section
Where patients are discharged
back into the community
Where to send the completed form
Where patients are admitted OR transferred
ward-to-ward/unit or discharged to other hospitals/units
Send this form to the GP and other receiving professional
or facility e.g. District nurse, care home.
Send to the receiving facility.
* NB The GP must also receive a copy of this form with the discharge letter
unless the patient’s infection status, swab results, and any treatment
information is already clearly included in the discharge letter (including any
swabs taken where awaiting results). If results come back after the patient
has left the ward, ensure results are sent to the GP.
NB Where patients are transferring ward-to-ward/unit or being discharged
to other hospital/units and are already on the MRSA pathway ensure it is clear /
up to date and send with the patient to the receiving hospital / ward/unit. In the
‘relevant specimen results’ box below record ‘see MRSA pathway’.
Form sent to:
GP
*
District Nurse (if applicable)
Care Home
(if applicable)
Ward or hospital (if applicable)
Other- state:
Copy to Infection Control Team
Copy retained in notes
 Yes




 Yes
 Yes
Signature of staff member completing form: ...........................................
Print name: ……………………………………………………………………….
Contact number: …..…………………………………………………………….
Date……………………Time………………………..
For any advice, please contact the Infection Prevention and Control Team Tel: 01255 206248 / 206244 V.7 Feb 10 . Review Feb 11
Owner: Infection Prevention and Control Team
Version: 6
Page 102 of 104
Review: December 2014
SECTION 10 – REFERENCES
BSI Specification for the planning, application and measurement of cleanliness services in hospitals
(2011)
Dougherty L, Lister S (2008) The Royal Marsden Hospital Manual of Clinical Nursing Procedures.
7th ed: Blackwell. Oxford
Department of Health (2009) Health Technical Memorandum 01-05: Decontamination in primary
care dental practices
Department of Health (2006) Immunisation against infectious disease (The Green Book). London,
2006
Department of Health (2003), Winning Ways: working together to reduce health care associated
infection in England. London:DH, 2003
Department of Health (2004). Towards cleaner hospitals and lower rates of infection: A summary of
action. London:DH 2004
Department for Health (2005). Saving Lives: a delivery programme to reduce health care associated
infection. London:DH, 2005
DOH The Health and Social Care Act 2008, Code of practice for the prevention and control of
infections and related guidance (Published December 2010). London
DoH (1998) Guidance for Clinical Health Care Workers; Protection against infection with bloodborne viruses. London.
Department of Health (2007) Saving Lives, High Impact Intervention No7: Reducing the risk of
infection from Clostridium difficile
Department of Health (2006) Saving Lives, Screening for Meticillin-resistant Staphylococcus aureus
(MRSA) colonisation
Department of Health (2006). Essential Steps to Safe, Clean Care: Reducing health care associated
infection. London: DH, 2006
Department of Health, (2006), Infection Control Guidance for Care Homes
Handwashing - Please see the Hand Hygiene Policy and Procedure ACE273
HPA Staphylococcus aureus FAQ
www.hpa.org.uk/infections/topics_az/staphylo_FAQ.htm
HPA Staphylococcus aureus/PVL FAQ
www.hpa.org.uk/infections/topics_az/staphylo/pvl_FAQ.htm
Health Protection Agency,2006; “Migrant Health: Infectious disease in non-UK born populations in
England, Wales and Northern Ireland. A baseline report 2006”
http://www.hpa.org.uk/Topics/InfectiousDiseases/InfectionsAZ/MigrantHealth/
Owner: Infection Prevention and Control Team
Version: 6
Page 103 of 104
Review: December 2014
Health Protection Agency (List of Infectious Diseases)
http://www.hpa.org.uk/Topics/InfectiousDiseases/InfectionsAZ/
http://www.dh.gov.uk/en/Publichealth/Immunisation/Greenbook/index.htm - accessed 24.12.10
Health and Safety commission (1974). Health and Safety at Work Act. HMSO. London.
Health and Safety Executive (reprinted 2008). Control of Substances Hazardous to Health
Regulations approved code of practice and guidance (fifth edition). HMSO. London.
HPA (2007) A good practice guide to control Clostridium difficile
HPA ESBLs information sheet: www.hpa.org.uk/infections/topics_az/esbl/default.htm, accessed
24.12.2010
ICNA (Published 2005) Audit tools for monitoring infection control standards
NPSA 2007; Safer Practice Notice Colour Coding hospital cleaning materials and equipment
NHS Estates (2004) A matron’s charter: an action plan for cleaner hospitals
National Patient Safety Agency (NPSA) (2009). The Revised Healthcare
Cleaning Manual. www.nrls.npsa.nhs.uk/resources/EntryId45=61830
NHS Estates, Healthcare Facilities Cleaning Manual (2004)
NICE, Infection Control-Prevention of healthcare-associated infection in primary and community
care, Clinical Guideline 2 (June 2003)
NPSA National Colour Coding Scheme (2007). www.nrls.npsa.nhs.uk/resources/?entryid45=59810
NPSA (2007) The national specifications for cleanliness in the NHS: a framework for setting and
measuring performance outcomes. www.nrls.npsa.nhs.uk/resources/?entryid45=59818
Pratt, Loveday, Robinson, Smith, epic guideline team (2001) The epic project: developing national
evidenced guidelines for preventing health care associated infection. Phase 1
Pratt et al (2007) epic2: National Evidence-Based Guidelines for Preventing Healthcare-Associated
Infections in NHS Hospitals in England. Journal of hospital infection
RCN, Standards for infusion therapy (November 2005, reprinted with minor amends June 2007,
third edition, January 2010). London.
www.infectioncontrolservices.co.uk/clostridium_difficile.htm accessed 24.12.2010
WHO World Health Organisation (2009) Hand Hygiene: Why, How & When?
Owner: Infection Prevention and Control Team
Version: 6
Page 104 of 104
Review: December 2014