Download Infection Prevention and Control in General Practice

CCG Recommended Policy for Infection Prevention and Control in
General Practice
Purpose of Agreement
To provide clear guidance on infection prevention
and control to General Practices in order to reduce
avoidable Health Care Associated Infections
(HCAI)
Document Type
Policy
Reference Number
Q&S/003/V.1.0
Version
Version 1.0
Name of Approving Committees/Groups
Joint Quality Assurance Committee May 2015
Governance Committee July 2015
Operational Date
1st August 2015
Document Review Date
1st August 2016
Document Sponsor
Louise Spencer Deputy Chief Quality Officer/Nurse
Document Manager
Ann Bishop
Lead Nurse Infection Prevention and Control Team
Document developed in consultation
with
Solent NHS Trust
Intranet Location
Primary Care Information Portal (PIP)
Website Location
Both CCG websites
Keywords (for website/intranet
uploading)
Infection Control, Infection Prevention, Standard
Precautions, Hand Hygiene, Sharps, PPE
Review Log
Include details of when the document was last reviewed:
Version
Review Date Name of
Ratification Process
Number
reviewer
Reason for
amendments
Amendments Summary:
Amend
Issued
Page
Subject
No
Infection Prevention and Control
Standard Precautions Policy
Action
Date
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INDEX
SECTION
CONTENTS
PAGE
1.
Introduction
3
2.
Scope
3
3.
Standard Precautions
3
4.
Hand hygiene
4
5.
Cleaning and decontamination
5
6.
Safe handling and disposal of waste
6
7.
Sharps safety
7
8.
Personal Protective Equipment (PPE)
8
9.
Safe handling of blood and body fluid spillage
9
10.
Respiratory hygiene
11
11.
Asepsis
11
12.
Management of chronic leg ulcers
12
13.
Wound swabbing
13
14.
Success Criteria/Monitoring Compliance
14
15.
Review
14
16.
References
15
Appendix 1
Poster: Catch It, Bin It, Kill It
16
Appendix 2
Flowchart: Inoculation or Contamination Injury
17
Appendix 3
Decontamination Certificate
18
Appendix 4
Standard Operating Procedure: Management of spillages of body fluids
excluding blood
19
Appendix 5
Standard Operating Procedure: Management of blood spills
21
Appendix 7
Safe Disposal of Healthcare Waste Guide
22
Appendix 8
Hand Hygiene posters
23
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1.0 INTRODUCTION
1.1
Health-care associated infections (HCAI) can be acquired following healthcare intervention
within any inpatient or community setting.
1.2
Much of the morbidity and mortality associated with HCAI is preventable.
1.3
Public and political interest is heightened to the rates of HCAI
1.4
Standard Precautions (previously known as Universal Precautions) are the basic level of
infection control practices that when used consistently and diligently reduce the transmission
of pathogenic organisms from both recognised and unrecognised sources.
1.5
Implementation of standard precautions results in significant decrease in the number of
Healthcare Associated Infections (HCAI) ultimately protecting patients, staff and visitors.
1.6
Every member of staff is individually responsible for implementing standard precautions in
their own practice to reduce the risk of infection to patients/service users, colleagues and
themselves.
1.7
Standard Precautions are applicable in all healthcare settings, in hospitals, clinics, surgeries
or in the patient’s own home/place of residence
2.0
SCOPE
2.1
This document sets out to provide clear guidance on infection prevention and control in
General Practices to minimise acquisition of HCAI and protect the workforce.
3.0
STANDARD PRECAUTIONS
The following elements of practice form the basis of Infection Prevention Standard
Precautions
Element 1: Hand hygiene
Element 2: Cleaning and decontamination
Element 3: Safe handling and disposal of waste
Element 4: Sharps safety
Element 5: Personal Protective Equipment (PPE)
Element 6: Safe handling of blood and body fluid spillage
Element 7: Safe handling and disposal of Linen
Element 8: Respiratory hygiene
Element 9: Asepsis
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4.0
HAND HYGIENE
Hand hygiene is recognised as one of the most effective methods to prevent the transmission
of pathogens and is a central component of standard precautions.
Micro-organisms on hands are either resident flora or transient flora. Resident flora are
usually of low virulence. Transient flora may contain many different pathogenic microorganisms. They are not firmly attached to the skin and can easily be removed by correct
hand hygiene.
The purpose of hand hygiene (both washing and drying) is to remove transient flora.
Dedicated hand wash basins should be available in all clinical areas. These should be elbow
or wrist operated taps and must not have a plug. They must not be used for the disposal of
other fluids.
Hand washing Agents
Gentle liquid soap is all that is required for general hand washing in clinical practice. Foaming soap
is not suitable in clinical areas, Ideally the dispenser will be wall mounted
Chlorhexidine agents i.e. Hibiscrub or Providine Iodine 7.5% should only be used prior to minor
surgery. This should not be used for general hand hygiene
Hand washing Technique
1.
2.
3.
4.
5.
6.
7.
8.
Adjust water to comfortable warm temperature
Thoroughly drench hands
Apply one dose of liquid soap
Perform six step technique (see diagram 1) Remember to include wrists, thumbs, finger
tips and between the fingers This should take at least 15 seconds
Thoroughly rinse
Dry using single use paper towels, never cloth towel
Dispose of in domestic waste stream
Turn tap off using wrist or elbow lever – if twist taps use a clean paper towel as taps will
be contaminated
When to Wash Hands
World Health Organisation (WHO) 5 Moments for Hand Hygiene
1.
2.
3.
4.
5.
Before direct patient contact
Before clean/aseptic procedure
After handling body fluids
After touching a patient
After contact within the immediate vicinity of the patient
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General Principles

Soap and water must always be used for hand hygiene when hands are visibly soiled i.e.
following handling of blood or body fluids or when caring for patients with suspected or
confirmed Clostridium difficile or diarrhoea of unknown origin.

Alcohol gel/hand rub can be used when hands are visibly clean.

Clinical staff must adhere to ‘bare below the elbows’ to enable effective hand hygiene

Cover any cuts/sores or lesions with a waterproof plaster.

Hands must always be cleaned following removal of PPE.

Protect skin integrity - Use moisturiser when appropriate, seek medical advise for
persistent problems
Dedicated hand wash basins should be available in all clinical areas and not be used for
any other purpose
Annual hand washing training is recommended for all clinical staff


See appendix 8 for posters
5.0
CLEANING AND DECONTAMINATION
Safe and effective decontamination of equipment and environment between patients is an
essential part of standard precautions.
Medical Equipment

Where practicable single use disposable equipment should be used for high risk or invasive
procedures.

Reusable instruments (if used) that must maintain sterility i.e. wound or minor surgery must
undergo high level disinfection according to manufacturer’s instruction to protect service
users and staff.

Single use items must never be reused.

Single patient use items must be securely retained for one named patient for a period of
time which is usually determined by the manufacturer or agreed with Infection Prevention &
Control Team (IPCT).

Local decontamination units can be utilised for the correct, validated cleaning of certain
medical items. Contact the IPCT for advice.
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
A decontamination certificate (appendix ? ) must be completed and attached to any item of
equipment being sent for repair, or loan
Cleaning must meet NHS Cleaning Standards

Correct storage of sterile instruments

All packages / boxes must be stored off of the floor to avoid contamination and facilitate
effective cleaning.
All sterile packages should be stored in cupboards with doors or enclosed drawers.
Sterile packages that become wet are no longer sterile
Before use examine external packaging for damp, damage the sterile indicator strip if
reprocessed items and expiry date. Any item failing these must be considered unsterile and
reprocessed or disposed of as applicable.
Regular checks on stock levels, and expiry dates.




Environment
 General everyday cleaning requires detergent, water and effort.
 All rooms and corridors must be cleaned with a suitable detergent and vacuumed regularly
(if appropriate)
 Clinical areas must be cleaned daily and specific areas cleaned as required ie counter tops,
examination couches
 Toilets must be cleaned at least daily
 The general fabric of the building can impact upon the ability to clean effectively ie broken
tiles, crack to plasterwork.
 Enhanced cleaning must be undertaken following recognised infection risk or
contamination with blood or body fluids (see Appendices 4, 5, 6).
 Records of cleaning and related audits should be maintained locally.
6.0
SAFE HANDLING AND DISPOSAL OF HEALTHCARE WASTE
Healthcare waste has the potential to be toxic, hazardous and / or infectious. All staff have a
‘duty of care’ under the Health and Safety at Work Act (1974) and the Environmental
Protection Act (1990) to ensure that waste (including sharps) must be segregated, handled,
transported and disposed of in an appropriate manner to ensure it does not harm staff,
patients/ service users, the public or the environment.
General Principles

Waste should be disposed of at point of care in nearest appropriate bin. See appendix 2
for disposal

Waste bags must be changed before ¾ full, and at least daily.

Waste bags must be swan necked or secured with a plastic tie to produce a fluid tight
seal when closed.
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7.0

Holding waste bags slightly away from the body will reduce risk if accidentally containing
sharp object.


The waste bag must be clearly labelled or tagged with the generators ID as per local
protocol.
Waste bags must be stored in an appropriate container, which must always be locked or
within a locked compound.

Independent waste disposal contractors – must be registered waste carrier.

The waste storage/collection area should be inaccessible to animals and the public with
waste being stored in locked bins provided by the waste contractor.
SHARPS SAFETY
Injuries from health-care sharps pose a significant risk to the physical and mental health of
staff, cost the healthcare organisation time and resources and have the potential to result in
costly litigation.
General principles

Staff are responsible for the safe use and disposal of every sharp they generate
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 Sharps must be handled with care and respected as potentially dangerous items.
 Never re-sheath needles
 If there is any safety device present on the syringe use it according to manufacturer’s
instructions
 Staff are recommended to maintain their own vaccinations up to date
Sharps disposal
 Sharps containers must be correctly assembled, tagged and labelled with start date,
surgery and the initials of the person assembling it.
 Use the correct colour sharps bin (see Appendix 7)
 Sharps bins must be BS7320 compliant
 Do not over fill the sharps container, dispose of before 2/3 full as indicated by the ‘Full
line’.
 Containers must be stored in an appropriate place, off of the floor and away from children
and vulnerable adults. Wall securing devices are available.
 Use ‘safer sharps’ devices when available
 Partially close the lid when not in use.
 Dispose of needles and syringes as one complete unit – do not disconnect the needle.
 Always take the sharps container to the point of use.
 Carry container only by the handle or on correct size designated sharps tray.
 Dispose of in designated area having securely closed, labelled, tagged and signed.
 Dispose of sharps bin after 3 months even if not full.
In case of Needlestick/ sharps injury refer to appendix x
8.0
PERSONAL PROTECTIVE EQUIPMENT (PPE)
Wearing PPE serves to protect the healthcare worker from contamination with blood, body
fluids or pathogens and to prevent the onward transmission of potentially pathogenic
microorganisms onto service users, colleagues, or to their own family members.
However gloves should not be worn unnecessarily as their indiscriminate use may cause
adverse reactions and skin sensitivity. Gloves must conform to European Community (CE)
standards, powdered or polythene gloves are not suitable in healthcare
The use of PPE should be guided by risk assessment and the extent of anticipated contact
with blood, body fluids or pathogens,
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Assess the risk
No Blood or body fluid
No known infection
No PPE
Except aprons for bed
making
Blood or Body Fluids
but
low risk of splashing
Blood or Body Fluid
with
high risk of splashing
Non sterile gloves &
aprons
Non sterile gloves &
Apron or gown & eye
and face protection
The minimum PPE that must be immediately available for all clinical staff in each clinic room is  Plastic aprons.
 Non sterile (general use) and sterile gloves (for aseptic procedures).
 Eye and face protection – fluid / splash repellent standard.
Aprons and gloves should be stored in an appropriate wall mounted dispenser or similar so that
the potential for contamination of these items is kept to a minimum prior to use.
General principles
Aprons or gowns
 Aprons are inexpensive yet effective at reducing contamination to the front of clothing
where most contamination occurs.
 Aprons are single use items and must be changed between patients.
 Aprons must be changed between dirty and clean procedures on the same patient
 Long sleeved water impervious gowns may be used if the risk of contamination is
excessive e.g. large blood or body fluid spillage or when skin to skin contact should be
avoided i.e. untreated scabies.
Gloves
 Gloves are NOT 100% impervious and hand washing after removal is essential.
 Gloves must be worn if contact with blood, body fluids, secretions, excretions or
hazardous substances are expected.
 Disposable gloves are single use items and must be discarded after each procedure.
 Gloves must be changed between dirty and clean procedures on the same patient
Masks, spectacles or visors
 Face protection or a mask should be worn for any activity where there is a risk of body
fluid splashing into the face or eyes.
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
Specialist FFP2 and FFP3 masks should only be used when indicated by Health
Protection Agency or Infection Control Team i.e. during a influenza pandemic
Remember - Staff will be less likely to wear PPE if it is not easily accessible.
Removal of PPE
PPE should be removed in a specific order to minimise the potential for cross- contamination.
This is gloves, apron / gown, eye and face protection (if worn).
Gloves
 Grasp the outside of the opposite gloved hand, peel off holding the removed glove in the
gloved hand.
 Slide the fingers of the un-gloved hand under the glove at the wrist, peel forward.
 Discard both gloves in clinical or offensive waste stream as appropriate
 Hand hygiene must follow removal of the final item of PPE.
Apron
 Pull ties to break.
 Pull away from neck.
 Wrap apron in on itself to contain the ‘dirty’ side – dispose in clinical or offensive waste as
appropriate.
 Hand hygiene must follow removal of the final item of PPE.
Goggles
 Handle by side arms.
 If disposable discard in appropriate waste stream or if reusable clean with detergent
wipe, dry and store.
 Hand hygiene must follow removal of the final item of PPE.
Face mask
 Break bottom ties followed by top ties.
 Pull away from face holding ties.
 Dispose of directly into waste.
 Hand hygiene must follow removal of the final item of PPE
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9.0
SAFE HANDLING OF BLOOD AND BODY FLUIDS
All blood and body fluids can potentially contain blood borne viruses or other pathogens.
Therefore, dealing with spills of blood or body fluid may expose the healthcare worker to
these blood borne viruses and spills must be dealt with swiftly, safely, effectively. (See
Appendices 4, 5, 6)
General Principles
Deal with spill quickly and effectively
Commercial spillage kits are available and must be stored away from children and vulnerable
adults.
Add some cleaning bit here
10.0 RESPIRATORY AND COUGH ETIQUETTE
Correct respiratory hygiene and cough etiquette is effective in decreasing the risk of
transmission of pathogens contained in large respiratory droplets e.g. influenza virus.
General Principles (Appendix 1)
 Cover mouth and nose when coughing or sneezing.
 Dispose of tissues immediately into appropriate waste bin.
 Perform hand hygiene frequently.
11.0 Asepsis
Aseptic technique is the term used to describe the actions taken to prevent contamination of
wounds and other susceptible sites by organisms that could cause infection.
Full asepsis using a sterile field, sterile equipment and sterile gloves or an Aseptic Non Touch
Technique ANTT) aim to achieve the same objectives – DO not contaminate key parts
Asepsis must be maintained during any procedure that bypasses the body’s natural defences ie
wound dressings, removal of sutures, endotracheal suctioning dressing tracheotomy site, urinary
catheter change , administration of Intravenous Medications
Components of Asepsis include






Hand Decontamination
Personal Protective Equipment
Preparing the Patient for a Clinical Procedure
Creating & maintaining an aseptic field
Use of a safe operative technique
Safe disposal of sharps & waste
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12.0 Management of Chronic leg Ulcers
The practice of soaking non infected chronic venous leg ulcers has become widely accepted as
offering physical and psychological benefits for some clients. However it is essential that the
healthcare professional ensures that the practice is correctly assessed and undertaken to minimise
the risk of cross infection to other wounds and to the environment.


Any signs of localised infection – stop social leg washing and revert to asepsis
Before commencing leg washing make sure there are the correct facilities for safe disposal.
This water MUST NOT be disposed of down a clinical hand wash basin.
Leg (Ulcer) Care - Washing and Dressing Procedure
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
11.
12.
13.
14.
15.
16.
17.
18.
19.
20.
21.
22.
Wash hands
Open dressing pack, apply apron, place on a suitable surface e.g. dressing trolley or tray not the floor
Place necessary equipment i.e. dressings, bandages, single use scissors, forceps, outer
padding etc and spatula for removing emollient within this field as required
Prepare bowl/bucket for social washing, line with single use polythene bag (bin liner)
Ensure tap outlet is cleaned with detergent wipe, run the tap for a minimum of two minutes to
flush before filling bowl
Add appropriate emollient/soap substitutes to the warm tap water
Add gauzes square or ‘inco wipe’ in order to wash leg
Prepare paper towels to dry leg and foot
Wash hands or use alcohol gel, apply non sterile gloves
Remove bandages/padding/stockings and dispose as per local waste policy. Retain
stockings/bandages as appropriate
Remove all primary/secondary dressings. Discard gloves
Wash hands and apply non sterile gloves
Wash leg. (If washing not indicated cleanse with appropriate sterile solution)
Dry leg in smooth downward motions and pat dry especially in between toes
Apply emollients/topical treatments to leg where appropriate. Use spatula to remove
emollient without contaminating emollient if not in a pump dispenser
After completing social washing, discard gloves, wash hands
If the second leg requires treatment repeat steps 4-16. (To prevent cross contamination it is
essential to use new bag liner, water, gloves, towels etc).
Apply sterile gloves and follow aseptic technique for wound dressings. (The wound bed/leg is
not sterile, but primary and secondary dressings are and should be applied without further
contamination)
Gloves may be removed for bandaging/ hosiery application
Finish procedure, wash hands and dispose of equipment and waste as per local policy
The bowls also need to be wiped with a solution of Actichlor after each use.
Bowls/buckets in all environments need to be dried thoroughly using paper towel and stored
inverted.
13.0 Taking a wound swab
Infection is a clinical diagnosis, microbiological sampling can only determine the presence of
organisms and their sensitivities.
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Therefore wound swabs should only be undertaken if antibiotics are indicated and not routinely to
check an infection has cleared for example.
Wherever possible microbiological sampling SHOULD be taken prior to the commencement of
antibiotics, however if a wound continues to deteriorate whilst on therapy ensure clinical details
contain current/recent antibiotic therapy, dose and start date.
Signs & Symptoms suggestive of infection








Increased pain
Erythema
Deteriorating wound
Increased exudates
Unpleasant odour
Cellulitis
Pyrexia
Patient generally unwell
How to Swab
1. Use the swab in it’s dry state on the wound and then place into the transport medium and
charcoal to aid the survival of fastidious organisms
2. Clean the wound first to remove the surface contaminants
3. Swab viable tissue displaying signs of infection, rotating the swab gently to increase pick
up whilst avoiding trauma to wound bed
4. Microbiology request form must include three points of patient identification
5. Include good quality data on the request form such as:




Site swabbed
Description of wound
Current/recent treatment
Other signs of infection such as pyrexia
6. Ensure transport to the laboratory as soon as possible to aid survival of fastidious
organisms using the correct process
7. Look out for the results and ensure treatment is commenced if required
Remember infection is a clinical diagnosis and the presence of an organism without signs of
infection will not usually require treatment.
14.0 SUCCESS CRITERIA/MONITORING COMPLIANCE
 This policy will be published on PIP
 The policy will be presented at the next Practice Nurse Infection Prevention study day
 One member of staff (usually a practice nurse) should be appointed as Infection Control
Link. Solent NHS Trust provides Infection Prevention and Control advice to Fareham and
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Gosport and South Eastern Hampshire GP Practices and hosts study days to provide
information, support and advice
 Infection Prevention should be discussed at clinical / staff meetings when appropriate,
issues raised and an action plan documented along with a responsible person
 The practice should aim to provide assurance that the risks of HCAI are minimised and that
services are delivered in a safe and clean environment
 The Infection Prevention Quality Improvement Tool is recommended as an audit against
best practice and to demonstrate improvements. This can be accessed via this hyperlink in
both word and pdf document. Scroll down the page to below PIT (Process Improvement
Tools) and pick GP Surgery/Health Centre
http://www.ips.uk.net/professional-practice/quality-improvement-tools/quality-improvement-tools/
15.0

REVIEW
This policy may be reviewed at any time at the request of either the Infection Prevention
Team or CCG/Practice Staff. It will automatically be reviewed twelve months from initial
approval and on a bi-annual basis unless organisational changes, legislation guidance or
non-compliance prompt earlier review.
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16.0 REFERENCES
Ayliffe,G.A.J. Babb,J. R. Taylor, L. J. 2001 3rd Ed. Hospital-Acquired Infection Principles
and Prevention. Arnold London
Department of Health (1998). Guidance for Clinical Healthcare Workers: protection against
Infection with Blood Borne Viruses. Recommendations of the Expert Advisory Group on AIDS and
the Advisory Group on Hepatitis. Department of Health: London
Department of Health (2007). Clean, safe care. Reducing infections and saving lives. Department
of Health: London.
Department of Health and Health Protection Agency (2010). Pandemic (H1N1) 2009 Influenza. A
summary of guidance for infection control in healthcare settings. Department of Health: London.
Garner, JS. (1996) Hospital Infection Control Practices Advisory Committee. Guideline for isolation
precautions in hospitals. Infection Control and Hospital Epidemiology.17(1):54-80.
Health and Safety Executive Advisory Committee on dangerous Pathogens 1995. Protection
Against Blood Borne Infections in the workplace: HIV and Hepatitis. HMSO, London
Health and Safety Executive (1992) Personal Protective Equipment at work. Guidance on
regulations. L25. London, Health and Safety Executive.. The Personal Protective
Lawrence,J.,May,D. 2003. Infection Control in the Community Churchill Livingstone Guidance for
Clinical Healthcare Workers: Protection Against Infection with Blood Borne Viruses.
Recommendations of the Expert Advisory Group on AIDS and the Advisory Group on Hepatitis.
1998 Department of Health, London
Pratt et al (2007). epic2: National Evidence-Based Guidelines for Preventing HealthcareAssociated Infections in NHS Hospitals in England. The Journal of Hospital Infection. 47
(supplement).
The Health and Social Care Act 2008. Code of Practice for health and adult social care on the
prevention and control of infections and related guidance. Department of Health: London.
Wilson J (2006). Infection Control in Clinical Practice 3rd edition. Bailliere Tindall: Bath.
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APPENDIX 1
Appendix 1
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APPENDIX 2
INOCULATION OR CONTAMINATION INJURY
(Sharps, bites, cuts, scratches or splashes of blood or body fluids)
1
Immediate attention required to attend to injury.
2
Allow to bleed, do not apply pressure or suck wound.
3
Wash thoroughly under running water with soap.
4
Dry well and apply waterproof dressing.
5
If body fluid splashes into eye irrigate with water.
6
If body fluids splash into mouth, do not swallow, rinse well with cold water.
7
Report to manager.
8
Injury from clean unused sharp – no further medical follow up.
9
Injury from contaminated instrument – Risk assess by General Practitioner, Occupational
Health or A&E Team.
10 Complete incident form.
11 Manager to commence investigation.
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APPENDIX 3
DECONTAMINATION CERTIFICATE
From (consignor) ..................................................... To (consignee): …………………………………
Address: ...................................................................
Address.................................................................
...................................................................
.............................................................................
...................................................................
.............................................................................
Reference: …............................................................
.............................................................................
Telephone number: ..................................................
Type of medical device (equipment):
.......................................................................................................................................................
Manufacturer:
.......................................................................................................................................................
Description of equipment:
.......................................................................................................................................................
Other identifying marks:
.......................................................................................................................................................
Model No. ………................................................................ Serial No. .....................................
Fault:
...................................................................................................................................
Is the item contaminated? Yes/No
Don’t Know
Ring/delete as appropriate
* State type of contamination: blood, body fluids, respired gases, pathological samples, chemicals
(including cytotoxic drugs), radioactive material or any other hazard
......................................................................................................................................
Has the item been decontaminated? Yes/No Don’t Know Ring/delete as appropriate
Cleaning: ..................................................................................................................................
Disinfection: ..............................................................................................................................
Sterilisation: ..............................................................................................................................
Please explain why the item has not been decontaminated?: ..................................................
……………………………………………………………………………………………………………
This
item has been prepared to ensure safe handling and transportation:
....................................................................................................................................................
Name: .................................................................... Position: ...........................................................
Date: ...................................................................... Tel No. .............................................................
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APPENDIX 4
Infection Control Guidance on the
Management of spillages of body
fluids (excluding blood)
This guidance is for staff in the inpatient setting where cleaning products available and materials in
situ are regulated.
Spillages of body fluids may potentially expose health care workers, patients and visitors to
pathogenic organisms. The safe and effective management of such spillages is essential.
Spillages of blood and body fluids must be dealt with promptly. The Chlorine Releasing Agents
(CRA’s) that are required in the management of a spillage are regulated under the Control of
Substances Hazardous to Health Regulations (COSHH) and Healthcare staff must follow written
guidance within the product data sheet.
Management of Spills on Hard Surfaces

Always deal with a spillage immediately.

Wear disposable gloves and apron or gown. If risk of splashing wear eye protection.

Gather equipment as required – this may include clinical or offensive waste bags, paper towels,
detergent, water.

Carefully remove bulk of spillage i.e. vomit/faeces etc using paper towel or scoop - dispose of
directly into waste bag.

Clean the area with detergent, rinse and dry thoroughly.

If the spill was contaminated with blood refer to the separate guidance – Management of Blood
Spills.

If the spill is believed to be infectious the area needs to be disinfected using a Chlorine
Releasing Agent i.e. Actichlor Plus at 1,000ppm.

Make up solution of Actichlor Plus according to manufacturers instructions - for general
enhanced cleaning use 1 litre of cold water and add one x 1.7g tablets i.e. 1,000ppm solution.
This will take a few minutes to dissolve, do not shake or agitate container – it may splash or
explode. Allow the area to air dry if possible or allow contact time of 2 minutes before drying.

Remove PPE, dispose of waste and wash hands thoroughly with soap and water.
Management of Spills on Soft Furnishings Including Carpets

Always deal with a spillage immediately.

Wear disposable gloves and apron or gown. If risk of splashing wear eye protection.

Gather equipment as required – this may include clinical or offensive waste bags, paper towels,
water soluble laundry bags, detergent, water.
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
Carefully remove bulk of spillage i.e. vomit/faeces etc using paper towel or scoop - dispose of
directly into waste bag.

If the item can be removed i.e. curtains or cushions do so – place in appropriate laundry bag for
soiled items, secure and label. Follow internal processes for laundering.

If the item cannot be removed i.e. furniture or carpet - clean the area thoroughly with general
detergent solution and warm water. (Actichlor Plus must not be used on soft furnishings.)

Ensure that any contamination of surrounding surfaces is appropriately dealt with (see
instructions above).

Staff must contact domestic services and request a ‘steam clean’ of the item. This item must
remain out of use or cordoned off until fully cleaned and dried.
Warnings and Precautions
1.
Do not take Chlorine Releasing Agent ie Actichlor Plus internally.
2.
Do not spray Chlorine Releasing Agent solution.
3.
Do not use Chlorine Releasing Agent on soft furnishings
4.
Avoid eye and direct skin contact – follow first aid if required.
5.
Do not mix Chlorine Releasing Agent directly with acids including urine or vomit.
6.
Do not add any other detergents to Chlorine Releasing Agent.
7.
Avoid prolonged contact with stainless steel.
8.
Always dispose of used materials in appropriate waste stream.
9.
Store unused product in a secure dry place out of reach of children or vulnerable adults.
10. Whenever possible ensure good ventilation of area when using any Chlorine Releasing Agent
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APPENDIX 5
Infection Control Guidance on the
Management of Blood Spills
Dealing with spillages of blood or blood stained body fluids may expose health care workers to blood
borne viruses or other pathogens. It must always be assumed that any blood from any person poses a
potential risk and consequently the safe and effective management of such spillages is essential.
Spillages of blood and body fluids must be dealt with promptly. The Chlorine Releasing Agents (CRA’s)
that are required in the management of a spillage are regulated under the Control of Substances
Hazardous to Health Regulations (COSHH) and Healthcare staff must follow written guidance within the
product data sheet.
Procedure
1.
Wear disposable gloves and apron or gown. If risk of splashing wear eye protection.
2.
Place disposable paper towel/blue towel onto spill until absorbed.
3.
Make up solution of Actichlor Plus according to manufacturer’s instructions - for blood spills use 1
litre of cold water and add ten x 1.7g tablets i.e. 10,000ppm solution. This will take a few minutes to
dissolve, do not shake or agitate container – it may splash or explode.
4.
Gather other equipment required – clinical waste bags and paper towels for cleaning.
5.
Carefully pour fully dissolved Actichlor Plus solution over the paper towels.
6.
Leave for a minimum of 2 minutes, ideally for 5 minutes, to neutralise any potential blood borne
viruses.
7.
Dispose of waste in clinical waste bags.
8.
Clean the area thoroughly with general detergent solution or wipes.
9.
Dispose of unused Actichlor Plus solution immediately into drains with running water.
10. Remove PPE and dispose of as clinical waste.
11. Wash hands thoroughly with soap and water.
Procedure Blood Spills on Soft Furnishings including carpets
1. Always deal with a spillage immediately.
2. Wear disposable gloves and apron or gown. If risk of splashing wear eye protection.
3. Gather equipment as required – this may include clinical or offensive waste bags, paper towels, water
soluble laundry bags, detergent, water.
4. Carefully soak bulk of spillage using paper towels - dispose of directly into waste bag.
5. If the item can be removed i.e. curtains or cushions do so – place in appropriate laundry bag for
soiled/infected items, secure and label. Follow internal processes for laundering.
6. If the item cannot be removed i.e. furniture or carpet - clean the area thoroughly with general
detergent solution and warm water. (Actichlor Plus must not be used on soft furnishings.)
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7. Warning – Actichlor Plus is not compatible with soft furnishings therefore blood borne virus will not
have been neutralised at this point
8. Ensure that any contamination of surrounding surfaces is appropriately dealt with (see instructions
above).
9. Staff must contact domestic services and request a ‘steam clean’ of the item. This item must remain
out of use or cordoned off until fully cleaned and dried.
Warnings and Precautions
1.
Do not take Actichlor Plus internally.
2.
Do not spray Actichlor Plus solution.
3.
Do not use Actichlor plus on soft furnishings
4.
Avoid eye and direct skin contact – follow first aid if required.
5.
Do not mix Actichlor Plus directly with acids including urine or vomit.
6.
Do not add any other detergents to Actichlor Plus solution.
7.
Avoid prolonged contact with stainless steel.
8.
Always dispose of used materials in appropriate waste stream.
9.
Store unused tablets in a secure dry place out of reach of children or vulnerable adults.
10. Only standard strength solution of Actichlor plus can be retained in suitable screw top bottle
correctly labelled for 24hours. High strength solution used in management of blood spills must be
discarded immediately after use.
11. Whenever possible ensure good ventilation of area when using any chlorine product.
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APPENDIX 7
Safe Disposal
of Healthcare Waste Guide
Infectious - Orange Waste stream
•Contaminated items from known or
suspected infectious patients
•Infectious disposable PPE e.g. gloves, aprons
•Infectious outbreak waste
Non Infectious - Tiger waste stream
•Contaminated items from non infectious source
•Incontinence pads
•Nappies
•Non infectious disposable PPE eg Gloves, aprons
Domestic waste stream
•Paper towels
•Tissues
•Food waste
•Non contaminated couch roll
Sharps and all
Medicinal Waste
Cytotoxic &
Cytostatic
Medicinal
Sharps
Non
medicinal
Sharps
Dispose in
a purple
lidded
container
Dispose in
an orange
lidded
container
Medicinal
Sharps
Medicinal
Waste
(inc POM,
OTC)
Dispose in
a yellow
lidded
container
Dispose in
a blue
lidded
container
(e.g.
Bloods)
Recycling waste stream
•Plastic bottles
•Drinks cans
•Paper
•Cardboard
Waste segregation is the only sustainable option; it protects the environment and saves money
JK/Version 2/ WG/Nov 2011
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