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«Policy Number IC01 Policy Title INFECTION PREVENTION AND CONTROL POLICY Accountable Director Director of Infection Prevention and Control Author Lead ...»

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Contaminated Mattresses Mattresses which are contaminated internally with bodily fluids need to be placed into a clinical waste mattress bag, secured and disposed of as hazardous infectious waste. Large yellow clinical waste mattress sacks can be requested from the Infection Prevention and Control Department.

Note: All used mattresses awaiting collection (contaminated or not) need to display a completed Declaration of Contamination Status Form.

6.4.7 Contaminated Medical Devices Contact Infection Prevention and Control for advice regarding decontaminating medical devices which are no longer fit for purpose and that cannot be disposed of via existing waste streams e.g. Sphygmomanometers, suction machines.

After decontamination or packaging, special arrangements will be made with a waste management contractor for disposal, by the lead person for Waste Management and Declaration of Contamination Status Form must be completed and attached.

6.4.8 Non Clinical Bulk Waste - e.g. Redundant Furniture Redundant and condemned furnishings must if coming from any clinical area have a Declaration of Contamination Status Form attached.

Contact the Transport Department to arrange removal.

6.4.9 Key Points to Minimise the Risk

• All waste containers either partially full or awaiting collection must be stored safely and be inaccessible to service users, children and members of the public.

• Ensure that sharps bins are put together correctly and that the lid is locked down and aperture locked shut.

• All sharps box labels must be completed upon assembly and when ready for collection. This includes the unit, date when assembled, staff name or initials and date when full for collection. This information is required to assist the emergency services should there be an accident or an incident.

• Where items have been tagged, the record books of tagging must be retained for a minimum of 3 years.

• Used sharps must be discarded immediately by the person generating sharps waste, into an approved container conforming to current standards.

• Sharps containers must not be used for any other purpose than the disposal of sharps. E.g. batteries, medication etc.

• Sharps containers must be located in a safe position to minimise the risk of

Page 26 of 94 Infection Prevention and Control Policy

spillage and at a height that allows the safe disposal of sharps.

• Ensure temporary closure mechanism is utilised when sharps bin is not in use, to prevent accidental spillage.

• Sharps containers must be disposed of when the fill line is reached.

• Partially full sharps containers should be disposed of every 3 months by the licensed route.

• All sharps and clinical waste being disposed of in colour coded receptacles (bags/bins) must only be filled to 2/3rds full or to the fill line and secured.

• Bags should be carried by the neck and away from the body and should never be dragged or thrown.

• All sharps boxes must placed in a separate wheeled bin than other clinical waste. This is to reduce the risk of accidents or incidents should a sharps box leak or break.

• All clinical waste wheeled bins must be kept locked.

• Staff transporting sharps (used or unused) in their vehicles must ensure that they are managed using a safe system of working. Such as transporting devices in a robust secondary container. To ensure that others travelling in or servicing vehicles are not placed at risk.

Collection of Clinical Waste from Hospitals and Departments

Each ward/department has a designated waste storage area which must be kept locked. All waste and waste containers will be removed as arranged locally, and collected by Trust’s waste contractors. All staff handling waste must exercise due care and attention to avoid injury and or risk of infection.

Personal protective equipment must be worn.

Any bags/bins that are not effectively sealed or labelled will not be removed.

Collection of Clinical Waste from Homes or Departments in the Community A special collection of clinical waste and sharps is arranged with the local authority, and clinical waste containers stored in the grounds must be kept locked.

The Trust has a duty of care to ensure that all clinical waste is securely stored, transported and incinerated. Clinical waste must be identifiable with the location, date and name of person disposing of the waste.

6.5 Personal Protective Equipment (PPE) Personal protective equipment is used to protect staff and service users by reducing the risk of transmission of micro-organisms from the hands and clothing of staff to others and the environment.

–  –  –

6.5.1 Gloves Gloves should be worn to: Protect the hands from contamination with organic matter, micro-organisms and to reduce risks from sharp objects.

• Reduce the risks of transmission of infection to both service users and staff.

• Protect the hands when using cleaning products.

Gloves must be worn when:

• Dealing with blood or body fluids, secretions or excretions.

• Carrying out invasive procedures or when in contact with sterile sites, or non intact skin or mucus membranes.





• Cleaning and using cleaning products

• Whenever there use is specified in the COSHH data sheet of any chemical product.

• Put gloves on immediately before patient contact or treatment and removed as soon as the activity is completed.

• Change gloves between caring for different service users or between different care treatments for some service users.

• Gloves must be disposed of in appropriate waste stream.

• Hands must be decontaminated following the removal of gloves.

Types of Gloves

• Disposable gloves in all clinical areas that are latex free and conform to European Community Standards that are of an acceptable quality, non sterile gloves should be used as the norm.

• Sterile gloves should only be used for invasive procedures.

• Thicker colour coded rubber gloves are provided for domestic cleaning.

• Industrial gloves are provided for the portering staff for the handling of clinical waste and tins.

6.5.2 Plastic Aprons Are provided to protect clothing from blood or body fluids. They are designed to be single use and should be changed after each task or sooner if contaminated.

Disposable plastic aprons must be worn when:

• There is a risk that clothing may become exposed to blood, body fluids, secretions and excretions.

• Clothing or uniform may be exposed to dirty conditions e.g. when cleaning or handling used laundry.

• Full body water repellent gowns may be worn when there is a risk of extensive splashing of blood or body fluids.

Aprons must be changed:

–  –  –

• Between providing care for each patient.

• Between cleaning different areas e.g. bedrooms, bays, toilets, kitchens and clinical areas.

6.5.3 Masks

Must be worn when:

• There is a risk of splashing or spitting into the mouth.

• Using powdered or toxic spray cleaning materials.

• There is an outbreak of infection where aerosol contamination is a risk.

• As advised by the infection prevention and control team.

6.5.4 Eye Protection

Must be worn when:

• Powder cleaning substances or toxic spray cleaning substances are used.

• There is a risk of splashing to the eyes from blood or body fluids.

• Where there is a history of spitting into the face from a particular service user.

6.5.5 Coveralls Are to be worn when dealing with service users who have been involved in “dirty protests”. They are single use only must be disposed of into the appropriate waste stream after use.

6.6 Collection and Transport of Specimens Control of Substances Hazardous to Health Regulations 2003 “COSHH regulations set out the duty of employers to manage the risk of exposure to hazardous substances which is essential to prevent risks identified from potential sources of harm. This covers exposure to pathogenic microorganisms”.

Specimen Containers When collecting a specimen, care must be taken to avoid contaminating the outside surface of the container and the request form. The container used must be appropriate for the purpose. The request form must contain any information required by the laboratory staff for safe handling Handling of Laboratory Specimens

–  –  –

Specimens suspected or known to contain a hazard group 3 or 4 pathogen must have a biohazard label attached to the specimen and request form.

Examples of group 3 or 4 pathogens are: HBV, HCV, HIV, Salmonella, Shigella.

• Staff must wear gloves and aprons when handling specimens.

• Only approved laboratory containers are to be used.

• The form and each container must be labelled with the patient’s name and date of birth, clinical area, date of specimen collection

• Hazard labels must be applied on specimens from service users with known or suspected infections.

• The specimen must be placed in a plastic transparent specimen bag as soon as it has been labelled.

• The bag must be sealed.

• The request form indicating clinical details, relevant medication, tests required, specimen type and description if appropriate should be placed in the adjoining section of the specimen bag.

• Transport of specimens should be contained within two layers of containment, the second being robust and leak proof with a lid that can be secured in transit.

• Transportation of specimens will be in biohazard marked containers and all vehicles carrying specimens must display biohazard signs on the vehicle in case of an accident which requires assistance from others.

6.7 Indwelling Medical Devices

Many service users become infected because their body’s natural defences are breached when indwelling medical devices are inserted as part of the process of care. Staff caring for service users with indwelling medical devices must be competent and have received adequate training in their use and management.

Staff who are not competent or confident using these devices must contact the Infection Prevention and Control Team for advice and information on how to access training.

Catheterisation Catheter associated urinary tract infections (CAUTI’s) are caused by microorganisms on the service users skin which can gain easier entry to deeper tissues or the blood stream when catheters are introduced.

All staff involved in catheterisation and catheter care must be trained in Aseptic technique, catheter insertion and continuing care.

On going support/training of service users and carers can be accessed at any time during the period of catheterisation, this should include education regarding the need for hand decontamination.

The Clinical Team must also assess the need for catheterisation:

• Only use indwelling urethral catheters after considering alternative methods of management (e.g. intermittent catheterisation) and even then only for the shortest time possible.

–  –  –

• Document the need for the catheterisation.

• Document the date and time of: Insertion, care given, emptying and removal in the clinical notes as a matter of routine.

• Review regularly and document rational for continued use.

• Remove the catheter as soon as catheter is no longer required.

• All of the above must also take place if a patient is admitted with a catheter in situ.

• Prescribing antibiotics to service users with indwelling catheters must follow guidance as set out in the trust anti-microbial formulary.

• The urinary drainage bag should be emptied frequently enough to maintain urine flow and prevent reflux it should be changed when clinically indicated.

Enteral Feeding This is the means of providing nutrients and delivering them into the gastrointestinal tract by tube feeding.

Research has shown that up to 30% of feeds are contaminated with a variety of micro-organisms due to poor preparation or poor administration of feeds.

All staff involved in enteral feeding must follow the guidance contained in the Trust Enteral Feeding guidelines.

Peripheral vascular cannulation The Clinical Team must assess and document the reason for the intravenous line and it will only be used when there is no suitable alternative for the shortest time possible.

Insertion and removal of lines will be undertaken by a trained and competent staff using aseptic technique.

The date of insertion and date of removal of the device must be documented in the clinical notes.

6.8 Aseptic Non Touch Technique (ANTT) Only staff who have received appropriate training should carry out Aseptic Non Touch Technique (ANTT) following the guidelines in the Royal Marsden Hospital Manual of Clinical Nursing Procedures.

http://www.royalmarsdenmanual.com/online/toc.asp

6.9 Transfer and Discharge of Service users with Infections All clinical areas must inform on transfer or discharge the receiving area, the ambulance or transport staff, the relevant General Practitioner of the infectious status of the patient.

All infections treated or being treated must be noted in the discharge note and in the clinical notes with the diagnosis and treatment prescribed.

–  –  –

The inter-healthcare Infection Prevention and Control transfer form (Appendix1) must be completed when any infected patient is transferred or discharged.

6.10 Death of a potentially infected service user

Performing Last Offices:



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