«Policy Number IC01 Policy Title INFECTION PREVENTION AND CONTROL POLICY Accountable Director Director of Infection Prevention and Control Author Lead ...»
• Hand hygiene instructional posters are displayed, to raise awareness and compliance with effective hand washing technique.
• Infection Prevention and Control Clinical Area Assurance Checklists are completed in all clinical areas which include evidence of hand hygiene training (See Appendix 6) Individual Infection Prevention and Control is everybody’s business, and every individual working within the Trust has a duty to act in accordance with standard principles and procedures as set out in the Mersey Care NHS Trust, Infection Prevention and Control Policy at all times.
5.1Duty of The Infection Prevention and Control Committee The Infection Prevention and Control Committee has a duty to oversee the Annual Infection Prevention and Control Work Programme and reports regularly to the Trust Board via the Quality Assurance Committee on all Infection Prevention and Control activity.
6. Clinical Guidelines
6.1 Hand Hygiene - Decontamination of hands Hand washing is the single most important procedure for preventing healthcare associated infections. Body secretions, surfaces and hands of all healthcare workers can carry bacteria, viruses and fungi that are potentially infectious to them and others.
Hand washing significantly decreases the carriage of potential pathogens on the hands.
Service users are put at potential risk of developing a healthcare associated infection when a health care practitioner has contaminated hands. Hands must be decontaminated before every episode of care that involves direct contact with a patient’s skin, their food, invasive devices, or dressings, and after any activity or contact that potentially results in hands becoming contaminated.
Hands that are visibly soiled or contaminated with dirt or organic material must be washed with liquid soap and water which will remove transient microorganisms and leave the hands socially clean. This level of decontamination is sufficient for general social contact and most clinical care activities.
Mersey Care NHS Trust is committed to reducing the risk of hospital acquired infections by providing the hand hygiene products required to decontaminate hands, and the education and audit required to ensure compliance.
The Trust is committed to improving hand washing facilities in line with government guidance and this will be done through new builds and refurbishment programmes.
Hand Hygiene Training - See Section 4.5 Appearance and Workwear to support Effective Infection Prevention and Control Practice.
Maximum contamination of disease-causing bacteria has been found in the areas of greatest hand contact, for example pockets and cuffs may lead to the recontamination of washed hands. Rings, watches and bracelets have also
been shown to decrease the effectiveness of hand washing, therefore:
Staff working in clinical areas (including those working in community settings) should only wear minimal jewellery to maximise the effectiveness of good hand hygiene. Bracelets, and rings with stones should not be worn as they may harbour micro organisms, hinder thorough hand washing technique and can also damage PPE (personal protective equipment) such as gloves, reducing their efficacy. Staff working in clinical areas may wear a plain ring, watch, alert bracelet or Kara bracelet although wrist wear should be removed prior to handwashing when undertaking clinical procedures or for example when serving or handling food.
Uniforms should be laundered as per guidance in laundry section page 21 Shoes should be cleaned immediately if contaminated with body fluids, using general purpose detergent and hot water – disposable gloves should be worn.
Direct care staff (including community staff) should adopt a ‘bare below the elbows’ approach when undertaking clinical procedures or procedures that
require hand washing (Department of Health, 2010). Therefore:
(i) The sleeves of long sleeved tops such as shirts and blouses should be rolled back to facilitate hand washing/decontamination that includes the wrists and should remain rolled back whilst delivering care. Where, for religious reasons, staff wish to cover their forearms during patient care activity, disposable oversleeves may be worn. These must be put on and discarded in exactly the same way as disposable gloves and strict procedures for washing hands and wrists must still be observed (DoH, 2010).
(ii) Where ties are worn they should be either removed or tucked into the front of the shirt to prevent them from coming into contact with service users.
Fingernails should be short and free of nail varnish and particular attention paid to them when washing hands as most microbes on the hands come from beneath the fingernails. False nails and nail extensions are unacceptable within areas where direct care is delivered as they are a source of contamination and discourage vigorous hand washing.
Staff should report for duty clean and presented in a way that inspires confidence from service users and visitors Hair should be clean and tied back if longer than shoulder length in order to prevent interference with clinical procedures and other practical tasks.
Beards and moustaches should be kept clean in order to prevent interference with clinical procedures and other practical tasks.
Effective Hand Washing Technique Involves Five Steps,
Preparation requires wetting hands under warm running water before applying liquid soap. Hands should be rinsed and dried thoroughly.
The hands must be rubbed together vigorously for 10 to 15 seconds ensuring that the solution comes into contact with all surfaces of the hands and paying particular attention to the tips of the fingers, the thumbs and areas between the fingers.
Any cuts of abrasions on hands must be covered using waterproof dressings, which should be replaced if they become contaminated/soiled.
Hands washing instructional diagrams, should be displayed at all staff hand wash basins.
Hand Hygiene Instructional diagrams (see Appendix 8) Alcohol and other non alcohol based Hand Rubs The correct use of hand rubs on contaminated hands will result in a substantial reduction in numbers of transient micro-organisms, although hand rubs are not effective in removing dirt and not all hand rubs are effective against Clostridium difficile spores or some viruses such as Norovirus. Consequently they should not be used when caring for individuals experiencing symptoms of diarrhoea or vomiting When using hand rubs the staff must ensure that all surfaces of their hands come into contact with the solution, hands should be rubbed until the solution has evaporated and the hands feel dry, please follow manufacturers’ instructions on the correct amount of product to use.
The use of hand rubs is an alternative to the full hand hygiene with the exception of heavily soiled hands, or when dealing with service users with C.diff or D&V.
In some settings alcohol based hand rubs have been shown to pose a hazard.
For this reasons their use in any particular clinical area must be controlled and based on local risk assessment.
In the event that hand rub is ingested, medical advice must be sought immediately.
The 5 Moments for Hand Hygiene at the Point of Care The World Health Organisation’s 5 Moments for Hand Hygiene, is a simple way for healthcare workers to know when they should decontaminate their hands.
The 5 Moments for Hand Hygiene are as follows
1. Before Patient Contact
2. Before a Clean/Aseptic Procedure
3. After Body Fluid Exposure Risk (or dirty procedure, glove removal)
4. After Patient Contact
5. After Contact with the Patient Surroundings (For Poster see Appendix 9) Hand Cream and Skin Care Apply moisturisers regularly to protect skin from the drying effects of regular hand decontamination. Hand cream that contains emollients is important in maintaining skin integrity.
Frequent hand washing can damage skin integrity, and this has been shown to increase the potential for cross infection from micro organisms. If you encounter skin problems, please contact the Occupational Health Department.
6.2 Environmental Decontamination The hospital and community environments must be visibly clean, free from dust and soilage and acceptable to service users, their visitors and staff.
Service users and their relatives rightfully expect care to be delivered in an environment where risks are proactively reduced and the control of healthcare associated infections is a high priority in every part of the Trust.
Standards of cleanliness are often seen as a visible sign of the overall quality of care provided. The Trust works to the NHS Standards for Cleaning and the Health and Social Care Act to ensure that service users are cared for in an environment where the premises, equipment, fixtures and fittings are kept clean. Cleaning frequencies determine how often tasks are carried out and it is crucial that not only are they adhered to and monitored, but that checks and spot cleaning will be included and carried out when spillages or accidents occur and that this is built into the cleaning provision provided by the Trust cleaning policy.
Monthly Infection Prevention and Control Environmental checks are carried out by clinical area staff and annual audits care carried out by the Infection Prevention and Control Team. Audit reports highlight any deficiencies found and action plans are drawn up to ensure that shortfalls are addressed in a practical and prioritised way. Results of audits are reported in the Infection Prevention and Control Annual Report which can be found on the Infection Prevention and Control website.
Only furniture and fittings that are easily cleaned and can withstand decontamination should be purchased for clinical areas. Prior to disposal of surplus, broken or old furniture and fittings decontamination must be carried out and a declaration of contamination status certificate attached if appropriate.
(See Appendix 6) Carpets Carpets should generally be avoided and only be fitted after discussion and agreement with the infection prevention and control team.
Only vacuum cleaning machines which have HEPA-filtration should be purchased and used within the Trust.
All cleaning must be carried out in line with standards and frequencies as identified in the National Specifications for Cleanliness in the NHS 2007
During and after an incident or outbreak of infection frequency of cleaning will be increased in line with the cleaning standards policy.
Domestic Rooms and Equipment.
These rooms and the cleaning equipment within them must be kept clean and in good condition.
Body Fluid Spillages Disinfection is required for body fluid spillages.
Staff must deal with body fluid spillages that occur in the area in which they work at the time of the spillage.
Any staff responsible for decontamination has a duty under the Health and Safety at Work Act to do so safely and correctly to ensure that the workplace is free from hazard. All areas should have a body fluid spillage kit or spill wipe easily accessible for use.
Splashes of body fluids on walls, and surfaces, can be cleaned using high level disinfectant. Wearing appropriate PPE clean the area thoroughly, Dispose of cloths or towels into appropriate waste stream.
For body fluid spillages, contain and disinfect by utilising an approved spillage kit or spill wipe, Wearing disposable gloves and apron follow the instructions supplied within the kit.
Large body fluid spillages and extensive faecal smearing.
Contact the Infection Prevention and Control Team or Silver On Call (Out of hours) as contractors may need to be brought in.
During office hours, the Nurse in Charge must contact the purchasing department to bring in contractors.
If possible secure the contaminated area until it has been cleaned. If the spillage is in a passageway or day area that cannot be isolated please contact the Infection Prevention and Control Team for advice.
Decontamination of Area or Facility etc. Prior to Inspection and Repair If an area has been contaminated by a burst pipe, toilet or sink being blocked, then the area or facility should be cleaned as far as is possible (flood, body fluid spillage cleared, remove obvious blockage if possible) and the area that the contractors are to work in should be decontaminated with disinfectant and the contractors informed.
6.3 Decontamination of Linen and Laundry
The provision of clean linen is a fundamental requirement for patient care, this can reduce the risk of cross infection and enhances the patient experience.
Incorrect procedures for handling or processing of linen can present an infection risk both to staff handling and laundering linen, and to service users who subsequently use it.
The laundering process Many micro-organisms will be physically removed from linen by detergent and water, and most are destroyed by a high temperature wash (thermal disinfection). Any remaining micro-organisms are likely to be destroyed by tumble drying. Manual soaking / washing of soiled items should never be carried out. A sluice cycle or cold pre-wash should be used for all soiled items. Care should always be taken not to overfill the washing machine.
Manufacturers recommendations should be followed Heat resistant items must be processed in a cycle which reaches 71ºC (for not less than 3 minutes) or 65ºC (for not less than 10 minutes).
Heat labile items should be washed on the hottest cycle possible for that item Categorisation and segregation of linen It is the responsibility of the person disposing of the linen to ensure that it is segregated appropriately. All linen can be categorised into the following three
Clean Linen Clean linen must be protected from dirt and dust. Storage areas should be dedicated for the purpose and not used for other activities, the storage area should be appropriately designed to prevent damage to linen and to allow for the rotation of stocks.