Chapter 0 – Overall - Intro - NES · Chapter 0 – Overall - Intro Infection prevention and control is everybody’s business and an essential part of the delivery of high quality

Chapter 0 – Overall - Intro

Infection prevention and control is everybody’s business and an essential partof the delivery of high quality care. Care is provided in a variety of settings including people’s own homes, community based units, sheltered housing complexes, and care homes. The significance of infection prevention and control in these places, and others, has grown with the knowledge that more micro-organisms are developing resistance to the antibiotics we use.

Infection prevention and control is also viewed as an important aspect of health and safety, and the control of substances hazardous to health, or COSH. In fact, adhering to infection prevention and control guidelines is a requirement of several regulations so it’s a vital consideration. This DVD contains information that you need to prevent or control the risk of infection and provide a safe, clean, and health environment for those you are providing care or support to.

The first part is an induction programme which serves as an introduction to the subject for people new to the delivery of care in the type of setting mentioned. It also offers frequent opportunities to pause and reflect on how knowledge can be applied to your particular workplace. The remainder of the DVD contains the main programme which builds on the content of the induction programme and can help both new and experienced staff to broaden their knowledge or update their skills.

The main programme has units that describe the common causes of infection plus information on infections that you may typically encounter when delivering care. The units also describe the steps you should take if there is an outbreak of infection in the setting where you work. There are then a seriesof units related to each of the ten standard infection control precautions. These provide a description of the elements that you can take to protect the wellbeing of the people you care for, the safety of family and visitors, and of course your own health and that of your colleagues.

Accompanying the DVD in the pack is a CD which contains many useful links and guidance on how to get the best from the programme. It contains notes for trainers and supervisors, and a self-assessment form and activity sheet to record key learning points. Also contained within the CD is a printable workbook. The workbook features a range of activities for you to complete, either as an independent learner or as a team. This will help to consolidate

© NHS Education for Scotland 2011. You can copy or reproduce the information in this document for use within NHSScotland and for non-commercial educational purposes. Use of this document for commercial purposes is permitted only with the written permission of NES.

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your learning and will give you evidence of the skills and knowledge you have to prevent infections in care.

There is guidance on how to complete the workbook but it may be helpful to read it over and complete it unit by unit as you watch the main programme. If you prefer you can complete the interactive PDF version online and save it in your personal files. Some care staff may choose to complete the multiple choice questions available on the CD which can serve as a useful way of checking your knowledge on completion of the program or following refreshers and updates.

You will also find your certificate of completion on the CD which can be verified and signed by your manager or supervisor. Everyone has a part to play in preventing the risk of infection in the delivery of care; you, your colleagues, those you provide care for, and their family and visitors. Infection prevention and control requires a team effort, and by carrying out standard infection control precautions to the same standard we can help to ensure the highest quality of care possible.

Chapter – 1 Induction - 1.0-1.1

In all care settings, preventing and controlling infection is vital to protect the people you care for, the safety of visitors, your colleagues, and your own health. Some groups of people, including the very young, the old, and those with long term conditions, or who are immunocompromised are particularly susceptible to infections and less able to fight them. For them, any infection atall can be very serious and even life threatening.

It’s crucial that as a provider of care you have the knowledge and skills to helpprevent risk of infection and provide a safe, clean, and healthy environment. This short induction program introduces you to the ten standard infection control precautions. NHS Scotland has produced a national infection prevention and control manual outlining the minimum standards that should be carried out at all times.

These are called the standard infection control precautions, and are often referred to as SICPs.


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They are: One; hand hygiene, cleaning your hands properly and regularly.

Two; personal protective equipment, by this we mean disposable gloves and aprons and occasionally eye and/or face protection and fluid repellent masks.

Three; respiratory and cough hygiene, explains the simple steps to take to prevent passing on a cold or other illnesses.

Four; safe management of blood and body fluid spillages, this includes cleaning up spillages such as urine and vomit.

Five; occupational exposure management, this is about protecting yourself from needles, scratches, and splashes of body fluids such as blood.

Six; safe management of the care environment, which includes the cleaning offurniture and fittings. Eight; safe management of linen, this is about safely managing clean, used, and infectious linen such as bedding.

Seven; safe management of care equipment, this is the cleaning and maintenance of equipment such as wheelchairs, commodes, or hoists.

Eight: patient placement, for those you care for, which relates to the continuous assessment of infection risk and occasional need to temporarily separate an individual who has an infection from others to prevent it spreading.

Nine; safe management of linen, this is about safely managing clean, used, and infectious linen such as bedding.

Ten; safe management of waste including sharps, the correct management of waste which can be anything from soiled bed pads to household waste

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Chapter 1- Induction- 1.2-1.10

Carrying out hand hygiene properly and frequently is the single most effective way of preventing the spread of infection. Think of all the things you do every day using your hands, like scratching your nose or touching your hair.


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Your hands are covered in micro-organisms even when you think they are clean. These micro-organisms can spread to anything or anyone you touch. The most effective way to clean your hands whilst at work is to use alcohol based hand rubs. However, liquid soap and warm running water are best if your hands are visibly soiled, or you’ve been caring for someone with a suspected or known gastrointestinal infection, such as norovirus and clostridium difficile.

By protecting your own health you’ll help to protect others too. Intact skin is a major barrier against developing infections, so check your hands for any cuts or abrasions and cover any broken skin with a clean waterproof plaster. Nails should be kept short and free from nail varnish and nail extensions. Jewellery should be kept to a minimum and no stoned rings should be worn, but a plain band is permitted. You should also bare your arms to the elbow and remove watches and bracelets.

It is important to use the correct technique when undertaking hand hygiene. The following procedure describes the steps you should take to clean your hands properly with an alcohol based hand rub: One; apply a palmful of alcohol based hand rub from a dispenser into a cupped hand and cover all surfaces. Two; rub your hands together palm to palm. Three; rub the back of each hand with the palm of the other hand and interlace your fingers.

Four; rub palm to palm with fingers interlaced. Five; rub the back of your fingers to the opposing palm with fingers interlocked. Six; rub each thumb in turn, holding it in the opposite hand using a rotational movement. Seven; rub the tips of your fingers in the opposite palm in a circular motion. Eight; allow your hands to dry naturally, don’t use paper towels.

Alcohol based hand rubs and gels must not be used when hands are visibly soiled and dirty, when dealing with someone with diarrhoea and/or vomiting, after any contact with blood or body fluids during any outbreaks of norovirus or other diarrhoeal illness. In those cases hands must be washed using a liquid soap and warm running water. When using liquid soap and warm running water the following procedure applies.

One; wet your hands with warm running water, using a mixer tap if possible. Two; apply liquid soap from a dispenser and cover all of your hands to create a lather. Three; rub your hands palm to palm. Four; rub the back of each handwith the palm of the other hand and interlace your fingers. Five; rub palm to palm with fingers interlaced.


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Six; rub the back of your fingers to the opposing palm with fingers interlocked.Seven; rub each thumb in turn, holding it in the opposite hand using a rotational movement. Eight; rib the tips of your fingers in the opposite palm in a circular motion.

Nine; rinse your hands with running water. Ten; turn off any taps. If you have long handled taps use your wrists, but if not use a paper towel. Eleven; dry your hands thoroughly with paper towels. You may need to carry out hand hygiene a number of times throughout your working day. Here are some examples of when you may need to wash your hands.

On arrival at your place of employment, before work begins. Before and after helping someone with a meal. After you go, or have helped someone else to go to the toilet. When you have come into contact with blood and / or body fluids , for example urine or vomit. Before eating, handling, or preparing food. When you have taken off disposable gloves. And before you leave to go home.

The World Health Organisation have defined the key moments for hand hygiene. You may see this poster in healthcare premises or in your organisation. You should also encourage others around you to follow good hand hygiene too. It is recognised that washing hands frequently can result in irritation to the hands. It is therefore important to manage any skin problems, and in the right way. The NHS Education for Scotland Hand Dermatitis bookletprovides information in this area.

Activity one; pause now and think of five occasions where you may need to carry out hand hygiene, then record your thoughts on the activity sheet.

Personal protective equipment, often referred to as PPE, is available in your day to day work to help protect the people you care for, you, and your colleagues from the transfer of infections. It is a legal requirement of health and safety legislation. The most common types of personal protective equipment are disposable plastic aprons and disposable gloves. Occasionally you may need to wear face protection too, such as masks and visors.

Personal protective equipment should be used when there is a risk of hands or clothing becoming contaminated with body fluids, such as vomit or blood, or when you need to clean an area or a piece of equipment. Throughout your day you will also need to assess each task you undertake and ask yourself if you need to use PPE. Gloves come in a variety of sizes and should be close


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fitting. They should also be changed for each person you are caring for, and each new task.

Don’t carry gloves in your pocket, and never wash them or apply alcohol based rubs to them. Regardless of the task you have been doing you should always assume that your gloves and apron have become contaminated and must be removed with care to avoid cross-contamination. Gloves should be removed first, followed by the apron, then eye protect, and lastly a mask if worn. To remove your gloves you should grasp the outside of the glove with the opposite gloved hand and peel off.

Hold the removed glove in the gloved hand. Slide the fingers of the ungloved hand under the remaining glove at the wrist. Peel the second glove off over the first glove, then ensure correct disposal in the correct bin. To remove your apron, firstly unfasten or break the ties at the neck, letting the top half of the apron fall. Then unfasten or break the ties at your waist. Fold or roll the apron into a bundle, ensuring you do not touch the front of it.

Finally, ensure its safe disposal in the correct bin. Face protection is needed when there is a risk of blood or body fluids and other contaminating substances splashing onto your face. To remove goggles or a face shield handle only the headband or side. If disposable ensure its safe disposal in thecorrect bin. If reusable, place it into a designated receptacle prior to decontamination.

To remove a mask unfasten the ties, first at the bottom and then the top. Pull away from the face without touching the front of the mask. If disposable, ensure its safe disposal in the correct bin. If reusable, place into a designated receptacle prior to decontamination. You should always carry out hand hygiene after removing PPE. Activity two, pause now and think of five occasions when you will need to wear personal protective equipment.

You may also wish to find out where it’s stored at your workplace. Don’t forget to record your thoughts on the activity sheet. There are many diseases that can be spread through coughing and sneezing, the most common ones such as colds and flu can be spread rapidly, especially in environments where people live and work in close proximity.

It can also occur at any time of the year, not just during winter months. There are a few simple steps that you and those you care for can take to reduce the chances of becoming sick or passing colds and illness onto others. Always


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use disposable tissues to catch sneezes and cover coughs. Then put the used tissue immediately in the bin and carry out hand hygiene with liquid soapand warm running water.

Hankies that require washing or laundering are not ideal, instead you should try to provide paper tissues and encourage the people you care for to follow good respiratory hygiene. Flu immunisation for those who are eligible should also be encouraged. Activity three, pause now and note how you might encourage someone to carry out respiratory and cough hygiene and clean their hands after blowing their nose or sneezing. Then record your thoughts on the activity sheet.

By spillages we mean blood, body fluids such as urine, vomit, faeces, and sputum. Any spillage must be dealt with immediately to avoid potential exposure to infection, and to prevent accidents. Before undertaking any procedure staff should assess any likely exposure and ensure that PPE worn provides adequate protection. When dealing with spillages you should always put on a disposable plastic apron and gloves. You may also need to put on a mask and eye protection if there may be a risk of splashing.

For spillage of urine, vomit, or faeces, place paper towels onto the spill to soak up the excess liquid. Remove the spillage with the paper towels. Then disinfect the area with 1000 parts per million of available chlorine, or use a combined detergent chlorine releasing solution with a concentration of 1000 parts per million of available chlorine, before cleaning the area with hot water and detergent. Never use chlorine based cleaning products directly on a urinespill.

For blood spillage a kit may be available to help you, but you should always read and follow the manufacturer’s instructions and check the expiry date of the solutions. If there is no kit available you will be required to collect your PPE equipment and disinfectant of choice prior to decontaminating the spill. Within healthcare settings, chlorine based agents are used to decontaminate blood spillage and other body fluid spillage with blood. This may be similar to your place of work.

You must check your local policy for cleaning of blood and body fluid spillage, including the type of cleaning agent or disinfectant to use, and follow the manufacturer’s instructions for use. Also ensure adequate ventilation when using the disinfectants. Here is an example on how to decontaminate blood


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spillage using a chlorine based disinfectant. The same principles of your choice of PPE and safety measures apply when using disinfectants but follow the manufacturer’s instructions.

Put on aprons and gloves. If using granules, cover the spillage with granules and leave for the time recommended by the manufacturer before cleaning up with disposable paper towels and/or a scoop if required and available. If usingchlorine solution, 10,000 parts per million, cover the spillage with disposable paper towels and gently soak the paper towels with solution. Leave for three minutes or as per the manufacturer’s guidelines.

Then dispose of the materials in the designated waste bag. Wash the area with general purpose detergent and warm water and paper towels, then rinse and dry it. Discard the disposables into the waste bag which should then be disposed of into the appropriate bin. Remove PPE and dispose of it in the correct bin. Carry out hand hygiene.

Never use chlorine based products directly on a urine spill. If the spillage is ona carpet, or soft furnishings, and is heavily decontaminated you may have to discard. If the furnishing can withstand a chlorine releasing solution then follow the appropriate procedure for the type of spill. Alternatively, if it is safe to clean with detergent alone, follow your local procedures . If not safe to clean with detergent the item should be discarded All items used to clean up the spillage including any remaining contaminated disposable cloths or kitchen roll should be discarded in the correct waste bag. Activity four, pause now to briefly record what equipment you will need for dealing with spillages of blood and / or body fluids . Then record your findings on the activity sheet.

This precaution is about protecting you from potentially harmful items or substances, including sharps and spillages such as urine or blood. From time to time you may be exposed to sharps such as needles, broken glass, razors, or anything that may break the skin, this is called a sharps injury.

Should an injury occur, make the wound bleed gently under warm running water, wash with liquid soap, dry with a paper towel, then cover with a waterproof dressing and report the incident immediately. You should also ensure that the sharp is disposed of correctly. The same procedure is followedif you have a bite that breaks the skin, or blood splashes on an uncovered cut or abrasion. Splashes from body fluids must also be dealt with immediately.


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PPE should be changed straight away, and splashes to the eyes or mouth should be rinsed with copious amounts of water. You should follow local policies when reporting accidents and incidents. Vaccination is another way ofreducing your risk of acquiring certain infections such as influenza and hepatitis B. You should speak to your employer or occupational health department if appropriate to obtain further details regarding this.

Activity five, pause now and briefly record your local policy for reporting accidents and incidents. Record your findings on the activity sheet. When using the word environment we mean all furniture and fittings such as surfaces, floors, doors, blinds, showers, and toilets.

Dust and dirt can allow micro-organisms to multiply and spread. Effective cleaning is an essential step in preventing and controlling the spread of infection, and a cluttered and untidy environment can prevent this taking place. This aspect of infection prevention and control can be difficult to achieve in an individual’s own home. You do, however, have the potential to influence them to make changes in their environment which can be helpful for everyone. If you work in a setting such as a care home or community based unit the cleanliness of the environment is everyone’s responsibility.

An environment that is clutter free and clean inspires confidence for those who live, visit, and work there. Activity six, record whether your setting has a cleaning schedule and who is responsible to ensure it is completed and kept up to date. Record your findings on the activity sheet.

Delivery of care involves many different items of care equipment. Care equipment can generally be categorised in the following ways. Single use equipment is used once on a single person and then discarded. It must never be reused, even on the same person. Equipment that falls into this category includes dressing packs or syringes. Packages will be identified with a single use symbol, a two with a line going through which means you cannot use it twice. Single patient use equipment such as a hoist sling can be reused on the same person.

Reusable non-invasive equipment, often referred to as communal equipment, includes items such as mattresses, bed frames, wheelchairs, and walking frames. Keeping reusable items clean, fit for purpose, and well maintained, is everyone’s responsibility in order to prevent the spread of infection. Most


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items of equipment will have a specific cleaning procedure and an agreed schedule for its frequency, which you should find out about.

Some items such as hoist slings are for use with a named person and no other individuals. These slings are usually laundered. Always ensure you follow the manufacturer’s instructions. Commodes are used in care environments. The contents of commode pots are disposed of according to local policy, and they must be thoroughly cleaned after each use. Activity seven, pause now and find out about the local policy for: A; cleaning care equipment, and B; maintaining care equipment, and record your findings.

If the person you are caring for displays the signs or symptoms of infection, such as a high temperature, a rash, diarrhoea, or vomiting, it is important that you inform the person in charge. This is because it may be necessary to isolate the person from the rest of the community or household to care for them in a room of their own.

This can be a frightening or frustrating experience and staff should work closely with family, friends, and carers to ensure that everybody understands the importance of protecting the wellbeing of everyone else. Always remember that infections can spread rapidly, so it’s important that you report any signs of infection to your manager as soon as possible and ensure the entire team adhere to all of the standard infection control precautions.

Activity eight, pause now and think about how an individual may feel if they are separated from others, and what you might be able to do to reduce any anxieties that they may have. Record your thoughts on the activity sheet. The safe management of linen means dealing with the risks of cross-contamination of clean, used, and infectious items, such as bedsheets, towels, and duvets, as well as personal items such as clothing.

Used linen can harbour micro-organisms and these can be transferred through handling so it is important to understand the process for managing linen and laundry within your setting. You should wear an apron and gloves when the linen is contaminated with blood or body fluids. Such linen is referred to as infectious linen. First, remove the used linen by rolling or foldingthe linen into a bundle.

If there is faeces or vomit present this should be picked up using a paper towel and disposed of. Used linen should not be put on the floor, shaken, soaked, or rinsed. It should instead be placed as a bundle in the correct


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laundry bag. There will be separate laundry bags for used linen and infectiouslinen. The laundry bag should be close to hand so you don’t have to walk down a corridor with it.

You should remove your gloves and apron and carry out hand hygiene before handling the clean linen and completing the task. The same principles of hygiene apply for personal clothing and any other laundry items. Activity nine, pause now and find out about the system for managing linen and laundry within your setting. Record your findings on the activity sheet.

By waste we mean everything from household waste to incontinence pads. The safe management of all waste by those involved in the handling, transporting, and processing of it is an essential part of health and safety and general good hygiene. Your setting may use different coloured bags to manage this waste appropriately. Some waste will be recyclable, such as broken crockery, cardboard, and paper. Other waste, like household waste, can be disposed of through the routine domestic waste systems.

However, other waste may need to be segregated as hazardous or special waste, this will need to be placed in the correct coloured waste bags. All waste should be binned as soon as possible, and bags should not be over-full, only three quarters full. When handling waste soiled with body fluids you should always wear disposable gloves and an apron and place it in the correctly coloured waste bag.

Activity ten, pause now and record the arrangement for the safe segregation and disposal of infected waste and sharps. Record your findings on the activity sheet. This program has given you an insight into the ten standard infection control precautions. By following the guidance, being aware of local systems and procedures, and taking responsibility you’ll help to prevent infections and the spread of illness when providing care.

Chapter 2 – Causes of Infection

We are surrounded by micro-organisms, they’re found inside us, on our bodies, in our food, and in the wider environment. Most micro-organisms are harmless but some can have serious consequences, particularly for


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vulnerable groups including older people, or those with certain medical conditions. There are many different types of micro-organisms such as bacteria and viruses.

For example, salmonella enteritidis is a type of bacteria that causes food poisoning, and there are certain viruses that cause diseases such as norovirus infection or chickenpox. If you would like to find out more about different types of micro-organisms, antibiotics, and resistance, there is a basictutorial available to you via the link to the anti-microbial stewardship educational workshop on the accompanying CD.

Micro-organisms need the right conditions to grow, including warmth, moisture, and food. A single micro-organism can multiply to become many millions in a day. They are also highly adaptable and can change their structure to thrive even in hostile conditions. The chain of infections describes the way an infection spreads. They do so from one part of your body to another, or from person to person, from the environment, food, or even animals.

People can become infected through contact, so for an infection to develop and spread all of the links in the chain need to be present. The infectious agent is the micro-organism that can cause the infection, for example norovirus, influenza, or tuberculosis. A reservoir is a place where a micro-organism can thrive and reproduce, and these include people, equipment, food, dust, and surfaces.

Portal of exit is the way out from the reservoir. This might include diarrhoea, vomit, blood, or droplets from coughing and sneezing. Transmission is how the micro-organism is moved from one site to another. For example, this can be through hand contact or indirect contact via equipment. The portal of entry is the way the infectious agent can get inside the body, including through an open wound, or by being swallowed.

Susceptible host, this can be anybody, but some, including older people, those living and working in close proximity to each other, and people with weakened immune systems, are particularly susceptible to infection. In order for an infection to spread all links in the chain of infection must be in place. But the standard infection control precautions are the practical steps with which you as care providers must carry out to break the chain of infection.


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The further learning programs on this DVD together with the information and documents contained within the CD will give you the information you need to break the chain. Remember, micro-organisms need the right conditions to grow. All the links in the chain of infection need to be present for an infection to spread. and by following the right infection prevention and control measures you can break a link in the chain and stop infection spreading.

There will be occasions when an infection develops, so it is important to recognise the signs and symptoms. Infections occur when our body tissues are invaded by micro-organisms, and our immune system has to react. Every infectious disease will have its own specific systems, but for many the generalsigns will include a high temperature, a headache, diarrhoea and/or vomiting. Other symptoms, depending on the infection, could include a rash, for example from measles, shingles, or scabies.

Or a cough, for example a chest infection, pneumonia, or tuberculosis. It is important to remember that infection signs and symptoms may present differently depending on an individual’s age and any underlying illness they may have. For example, an elderly person with an infection may present with non-specific symptoms, but with increased frailty and deteriorating mobility, or having developed some degree of confusion.

They might not actually develop a high temperature as their immune system may not react the same way as that of a younger person. Some infections arereferred to as localised infections. This means it is affecting one part of the body, which can range from a simple wound infection to a urinary tract or respiratory infection. There is always the potential for a localised infection to become more serious and develop.

Signs of a wound infection include swelling of the infected area, pus forming in the infected area, redness spreading from the cut or graze, increasing pain in the wound, generally feeling unwell, and a high temperature or fever. If you are caring for an individual with any of these symptoms medical advice shouldbe sought. If in doubt, speak to your supervisor. If our immune system is unable to fight an infection and treatment is required it is important to try and identify the micro-organism causing the problem

This can only be achieved if an appropriate sample is taken. The most common samples taken are urine, faecal, and wound swab samples. All samples should be submitted in the correct sample container. For example,


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urine for micro-biological testing should be submitted in a sample bottle containing a preservative and not in a plain one.

When collecting a sample of urine it is important to try and obtain as clean a specimen as possible, such as a mid-stream sample. A sterile container should be used to catch the urine. Where this is not possible, it should be recorded as a clean catch specimen of urine. The sample should be added to the correct container, which should have a ‘fill to’ line. This is important as the white powder in the bottle is a preservative that keeps urine in the state it was in the bladder.

When someone you are providing care for develops diarrhoea without an identified cause, for example aperients given unnecessarily, or by eating something that is known to cause upset, it is important that you submit a sample. Diarrhoea is defined as the passing of three or more loose or liquid stools per day, or more frequently than is normal for the individual. If you place a faecal sample into a pot and it does not take the form of the pot it is not diarrhoea and should not be sent to the lab for testing.

Wound swabs should be submitted when an infection is suspected and the wound has the symptoms described earlier. It is important to remember that some superficial wounds may be colonised with bacteria but aren’t actually causing harm. When taking a wound swab it is important to clean the wound first and then take the wound swab across the wound in a rolling action so as to cover the whole of the wound bed.

As well as taking the sample correctly it is important to provide accurate information for laboratory staff as not every sample will undergo the same tests. Laboratory staff need to know why you have submitted the sample along with relevant background information. For example, it is insufficient to just write “wound swab” instead you should clearly state the site of the wound as it is acceptable to have some types of bacteria on a fairly superficial wound, but not to find the same bacteria in a deeper wound.

It is also important to document whether the individual in question had been on antibiotics prior to the sample being taken, and if so when they commenced, and which antibiotic was used. The more information you provide for the lab staff, the more accurate the result will be. The form should also be written clearly. Remember, laboratory staff are dealing with hundreds of samples on a daily basis.


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Chapter 3 - Specific Infections

Vulnerable people are more susceptible to developing infection and can take longer to recover, with some infections being life threatening. There will be some infections, micro-organisms, that you’ve seen in the news such as MRSA and clostridium difficile but you might not understand exactly what theyare, what symptoms they cause, how they’re transmitted, and how they can be managed or controlled.

Some of the most common infections andmicro-organisms associated with older and vulnerable people receiving care are: clostridium difficile infection, commonly referred to as CDI, C-diff, or C-difficile; norovirus; urinary tract infection; influenza, commonly referred to as flu; scabies; Meticillin-resistant Staphylococcus aureus, commonly referred to as MRSA; Panton-Valentine leucocidin Staphylococcus aureus, sometimes referred to as PVLSA.

Clostridium difficile infection; clostridium difficile infection or CDI, is a commoncause of intestinal infection and is mostly associated with individuals who have received antibiotics. Approximately 3% of healthy adults and 20% of hospitalised patients carry clostridium difficile in their gut without any harm caused.

CDI occurs when the balance of the normal bacteria in the large bowel is altered allowing clostridium difficile to flourish. This can occur due to antibiotics, gut surgery, laxatives, and drugs used for gastric conditions. Thoseat greatest risk are the over-65s with underlying illness who are on or who have recently had certain antibiotics. Immunocompromised people are also at risk, as are those who have experienced prolonged stays in healthcare settings.

Symptoms; CDI can cause diarrhoea of varying severity, right through to severe inflammation of the bowel which can sometimes be life-threatening. Diarrhoea may be bloody, and this must never be ignored. It is also foul smelling. A large number of clostridium difficile spores are excreted in the diarrhoea of patients with CDI, the spores can contaminate the environment for long periods of time and be a source of hand to mouth infection for others.

CDI is normally diagnosed by carrying out laboratory testing which shows the presence of clostridium difficile toxins in the faecal sample. It can be treated with specific antibiotics but there is a risk of relapse or reinfection from poor hand hygiene and the environment.


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Prevention and control; antibiotics are prescribed only if necessary, and always using the right antibiotic, the correct dose, and the appropriate length of treatment. Where possible, care for a person who is suffering from diarrhoea in a room on their own. Additional precautions are necessary, and these are called transmission based precautions. Meticulous hand hygiene with liquid soap and warm running water should be observed by all staff, the people you care for, and any visitors. Note that alcohol based hand rubs aloneare not effective against clostridium difficile.

Anti-diarrhoeal medication should not be taken by those who are infected. Always use disposable gloves and aprons. You should practice good standards of environmental cleaning and disinfection. Disinfection of contaminated equipment and the environment is necessary. For further advice, contact your health protection team, or infection prevention and control team. Always ensure you seek medical advice if a patient has CDI.

Norovirus; Norovirus is a group of viruses that can cause vomiting and diarrhoea, and is the most common cause of viral gastroenteritis. It is present all year round, but there is usually an increase in cases in the winter. Outbreaks are common in semi-closed environments such as hospitals, nursing and care homes, schools, and cruise ships. Outbreaks can be difficult to control due to the ease of transmission of the virus from person to person, and its ability to survive in the environment for a number of days.

Symptoms; the time between coming into contact with the virus until becoming ill can be twelve to forty eight hours. People with the infection usually stop having symptoms within two to three days but 40% of people can still have symptoms for several more days. These include vomiting, usually in the form of sudden-onset, diarrhoea, headaches, aching limbs and stomach cramps, a raised temperature, and a feeling of weakness.

The spread of the illness occurs through contact with an infected person, consuming contaminated food or water and indirect contact with contaminatedsurfaces or objects. Vomiting in particular can cause minute virus particles to travel through the air which can be inhaled or can land on surfaces which people can then pick up via their hands.

Norovirus can also survive on surfaces for at least a week. Prevention and control; where possible, individuals with symptoms should be isolated. Affected areas of the services should be closed to admissions and activities


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during the course of the outbreak. Your health protection team or infection prevention and control team should be informed, as should the care inspectorate. Apply standard infection control precautions at all times and ensure hands are washed with liquid soap and warm running water.

Alcohol based rubs alone are not effective in this situation. Infected staff must not attend work until they are free from symptoms for forty eight hours. Cleaning must be increased, with special attention given to items that people touch frequently, like door knobs or handrails. Commodes and other frequently touched items should be kept clean.

Urinary tract infections; urinary tract infections, sometimes referred to as UTIs,are very common and can affect anyone no matter what their age. They can be caused by many different bacteria and can be very painful for the infected individual. They are more common in women than men. Some UTIs resolve spontaneously, however others may require treatment with a short course of antibiotics.

Symptoms; general symptoms of a lower UTI are pain or burning when urine is passed, a need to go to the toilet frequently. Many people can feel the needto go to the toilet as much as every ten minutes. Pain in the lower abdomen isanother symptom. If an individual has a condition such as dementia, development of the UTI may result in a change in their behaviour, for examplethey may become agitated or restless, have hallucinations, or become unusually sleepy or withdrawn.

The symptoms of an upper UTI can include a high temperature, uncontrollableshivering, nausea, vomiting, and the affected individual may also complain of pain in their side, back or groin. If an individual has symptoms suggestive of an upper UTI medical advice should be sought as there is a higher risk of complications. Prevention and control; not all urinary tract infections can be prevented but there are some actions that can be taken to reduce the risk of one developing.

Do not use urinary catheters unless they are absolutely necessary and following an individual assessment. Drink plenty of fluids to prevent dehydration and to clear bacteria from the urinary tract. Go to the toilet whenever needed, rather than holding it in. Avoid the development of constipation.


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Emptying a catheter bag; a catheter drainage bag should be kept below bladder level and emptied before it becomes completely full to avoid backflow into the bladder, but it should not be emptied more often than necessary because this increases the risk of infection. The following procedure must be followed when emptying a catheter bag. Carry out hand hygiene and put on gloves and a disposable apron. Empty the bag into a clean container by releasing the drainage tap. The container should be disposable, or if reusable cleaned as per local policy.

Empty the contents into a toilet carefully to avoid splashing, and note the volume if required. Remove gloves and apron. Carry out hand hygiene and record the volume if required. How to change a catheter bag; the following procedure must be followed when changing a catheter bag. Remove the new bag and tubing from its packaging.

The drainage bag connection to the catheter must be kept sterile, therefore it should not be touched. Assemble the leg strap. Detach the used bag, holding the catheter to prevent backflow into the bladder. Do not pull or drag the catheter. Ensure that the catheter bag is effectively secured. Remove the cap and attach a new bag, making sure not to touch the end of the tube, otherwisemicro-organisms can be introduced, potentially causing infection.

Place the used bag into in an appropriate waste bag. Remove gloves and apron and place in the appropriate waste bag. Carry out hand hygiene. Record the catheter bag change and urine volume. Influenza, more commonlyreferred to as flu, is an acute viral infection of the respiratory tract. Flu is highly infectious and usually spreads easily through the coughs and sneezes of an infected person.

It can also be spread if you touch an infected person, for example by shaking hands. An infected person can actually be infectious for up to seven days before they start to feel any symptoms, this means they can be spreading the infection before they even know they have it. Sometimes flu symptoms can beconfused with common cold symptoms, such as a runny or stuffy nose, a sorethroat, and cough. However, a person with flu will have the following symptoms.

A high temperature, cold sweats and shivers, a headache, aching joints and aching limbs, fatigue and a feeling of utter exhaustion, gastrointestinal symptoms such as nausea, vomiting, and diarrhoea can also occur but are


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much more common in the young than the elderly. In the majority cases flu is not serious, it is just unpleasant, resulting in a few days in bed. However, for some people there can be severe complications, this is more likely if you’re very young, elderly, or have some other long standing illness such as diabetes, chronic lung disease, heart disease, or an illness that affects your immune system.

The flu season can have a significant impact on the wellbeing of individuals and it is important that your organisation is prepared for the flu season. This can be done by using the following advice.

Advise individuals who are at risk of complications if they become infected with the flu, and residents within care homes, to take up the offer of flu immunisation. Providers of social care should also consider providing flu immunisation to their staff. Ensure staff are aware of standard infection controlprecautions, and transmission based precautions, such as the correct use of masks, which should be readily available. Have clear plans for managing those with symptoms, for example, by ensuring staff who have been immunised are allocated to look after symptomatic individuals, or where possible by isolating symptomatic individuals.

Have clear plans for communication with colleagues and visitors. Staff should also be aware of what to do if they develop symptoms. If you think you are dealing with an outbreak of flu, contact your local health protection team or infection prevention and control team. They will be able to provide advice.

Scabies. Scabies is a condition caused by a small mite, by the name of Sarcoptes scabiei. Infection occurs when people have contact with the mite. Once it gets on the body it burrows under the skin and toxins released in the mite’s faeces create an allergic reaction. It can take up to five or six weeks before the itching starts. Scabies is transmitted from person to person by prolonged skin to skin contact. It is much less likely to be transmitted by sharing the clothes or personal items of an infested person as the mite dies outside the host within eight hours. Symptoms; a rash and intense itching can occur on particular areas of the body.

These include the wrists, backs of the hands, between the fingers, belt lines atthe waist, thighs and genital areas, armpits, beneath the breasts, knees, and ankles. The intense itching occurs particularly at night. Sometimes burrows


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and occasional vesicles can be seen. It can take up to six weeks after the initial infection for these symptoms to be evident.

Sometimes people who are very vulnerable can develop a more severe form of scabies called crusted scabies, or Norwegian scabies. The rash forms crusted lesions resulting in massive skin scale shedding which is highly infections, resulting in it being much easier to transmit the mite. The affected person must therefore be cared for in their own room. In this event, you must contact your health protection team or infection prevention and control team for further advice as the infection control precautions are slightly more enhanced in cases of crusted scabies.

Prevention and control; if one person is affected by scabies in your setting it isrecommended that you contact your health protection team or infection prevention and control team. If treatment of staff and other individuals is to be carried out, it will be reasonable to delay it so it can be done in an organised manner, as everyone needs to be treated at the same time. Follow the manufacturer’s instruction for the application of the cream or lotion. It is important to reapply the cream if the individual has washed their hands.

Once treatment starts, the thorough cleaning of bedding, clothing, and the wider environment is advised, although be reassured to know that once the mite is off the host it will die within eight hours. The treatment needs to be repeated seven days later to ensure any newly hatched mites are killed. Even after treatment the mite’s faeces remain, causing itching for up to another three weeks. Prescribed antihistamines can help with this.

MRSA; MRSA stands for Meticillin-resistant Staphylococcus aureus. It can liveharmlessly on the skin, but sometimes cause infection. Around one in three people carry Staphylococcus aureus in the nose or on their skin. It is not normally a risk to healthy people. MRSA is mainly spread from person to person through hand contact, and it is only detected by a laboratory.

This usually happens when a wound or another area of the body becomes infected, and it can be identified by taking a swab, for example from a leg ulcer or eyes, or by obtaining a specimen from urine or sputum. Hand hygieneis the most important way of stopping the spread of MRSA. It is not necessaryto isolate someone with MRSA outwith hospital settings. Sometimes you may hear that someone is colonised and not infected.


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Colonisation means that the bacteria are on the skin or in the nose but they are not causing any harm and do not need any treatment. Always check your local policy to ensure you are carrying out the correct procedures. Symptoms; symptoms will be related to where the infection is found, however most peoplewith MRSA are colonised and are not infected and will therefore have no symptoms. Prevention and control; the standard infection control precautions, a clean dust-free environment is key.

An individualised treatment plan is required for any infection. Panton-Valentine leucocidin Staphylococcus aureus. Panton-Valentine leucocidin Staphylococcus aureus, sometimes referred to as PVLSA, has emerged in recent years. The organism is usually associated with younger people, but it could affect anyone. If an individual has an infection caused by this organism it very often presents itself as recurrent skin boils, sometimes referred to as carbuncles.

It can also cause severe infections such as pneumonia, which can result in anindividual becoming very unwell. As with MRSA it is possible for an individual to be colonised with this bacteria whereupon it can start to cause problems if they have a break in their skin. If someone you are providing care for, or indeed a colleague, is suffering from recurrent boil-type infections they should be advised to seek medical advice.

Symptoms; symptoms will be related to where the infection is found, however,most people with PVLSA are colonised and are not infected and will therefore have no symptoms. Prevention and control; hand hygiene and standard infection control precautions, including environmental cleaning, are essential. A clean dust-free environment is key. If a swab is submitted from an affected area, the request form should state that the individual has recurrent boil-type infections.

An individualised treatment plan is required for any infection, this may include decolonisation treatment. All of these health risks thrive as a result of the chain of infection, so remember to break the chain and help to prevent and manage sickness. Recognise and report illnesses or signs of infections. And document and carry out infection prevention and control measures.

In addition to the standard infection control precautions, some further precautions may be required. Your health protection team or infection prevention and control team can advise you about these.


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Chapter 4 – Outbreaks of Infections

Despite everyone’s best efforts, outbreaks of infection may occur in your workplace. Outbreaks occur in community settings as well as care homes, and in places where people live in close proximity infection can spread rapidly.There is also the potential for a care worker to move an infection from one household to another, which could result in an outbreak if appropriate precautions are not carried out.

When two or more people have the same infection, or more people than expected have the same infection, the cases will be linked by a place and time period. There is a tendency to associate the term “outbreak” with just those micro-organisms that cause vomiting and diarrhoea, but there could be an outbreak of respiratory disease or skin infections. An outbreak can also be identified through specimens sent to a laboratory, with results showing similar infection. For example, a notifiable disease such as tuberculosis, or clostridium difficile infections.

If you suspect there is an outbreak at your place of work you must inform yoursupervisor or line manager immediately who should in turn inform the health protection team or infection prevention and control team. Your care inspectorate must also be informed as soon as possible, this is a legal requirement. The relevant team will provide guidance on the steps to be takento minimise the risks involved, and commence an investigation to establish the nature and extent of the outbreak.

It is important to provide sufficient information that builds a picture of the situation so that informed decisions are made. For example, how many episodes of diarrhoea and/or vomiting, when it began, and how many people are affected. It is also important to ensure that appropriate samples are obtained. Another requirement is to make sure those that are ill are receiving appropriate care, and that their relatives are well informed. Individuals with symptoms should be isolated, where possible, from those who are well until symptoms have subsided for at least forty eight hours.

Depending on the nature of the infection, for example diarrhoea and vomiting, staff, visitors, and family carers should also be excluded from the setting if they develop symptoms and until they too are symptom free for at least forty eight hours. Within community based units, any symptomatic attendees


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should be excluded as required. Your health protection team or infection prevention and control team will advise on the necessary procedures.

Staff must adhere to the guidance given by the relevant team regarding control of the outbreak and the following of procedures necessary for the prevention of further illness. Visitors to care homes or community based units must be informed about the situation and asked to follow any special measures that have been put in place. There are also guidance documents available from Health Protection Scotland on managing outbreaks of norovirusand respiratory infections.

These can be obtained from the Health Protection Scotland website, or your health protection or infection prevention and control teams. From the start of an outbreak to the point when it is declared over by the relevant local team, clear records must be kept. This will involve recording of symptoms in all individuals including staff and visitors, dates and times of when the illness started, and details on the collection and results of specimens.

Remember, recognise when someone might be ill with an infection that can spread to others. Ensure that infection prevention and control measures are followed by all staff, visitors, and family members. Be clear about the reportingsystems for potential outbreaks. Ensure that all information is documented. Following an outbreak of infection, it is important to reflect on how the outbreak was handled and discuss any problems encountered. This will help everyone to improve practices and may prevent infections in the future.

It is also a good idea to reflect on positive aspects and things that worked well, which you may then want to discuss with your health protection or infection prevention and control team.

Chapter 5 - Introduction to SICPs

The ten standard infection control precautions, sometimes referred to as SICPs, provide national guidance on infection prevention and control. This guidance is the minimum standard to be considered at all times when providing care in any setting. As a provider of care you must adhere to the tenSICPs to prevent the risk of transmission of micro-organisms from both recognised and unrecognised sources of infection.


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The ten standard infection control precautions are:

One; hand hygiene, cleaning your hands properly and regularly.

Two; personal protective equipment, by this we mean disposable gloves and aprons, and occasionally eye / face protection and fluid repellent masks.

Three; respiratory and cough hygiene explains simple steps to take to preventpassing on a cold and other illnesses.

Four; safe management of blood and body fluid spillages, this includes cleaning up spillages such as urine and vomit.

Five; occupational exposure management, this is about protecting yourself from needles, scratches, and splashes of body fluids such as blood.

Six; safe management of care equipment, this is the cleaning and maintenance of equipment such as wheelchairs, commodes, or hoists.

Seven; safe management of care equipment, this is the cleaning and maintenance of equipment such as wheelchairs, commodes, or hoists.

Eight; patient placement for those you care for is about continuously assessing the risk of infection and relates to the occasional need to temporarily separate an individual who has an infection from others to preventit spreading.

Nine; safe management of linen, this is about safely managing clean, used and infectious soiled towels, sheets, and clothing.

Ten; safe management of waste, including sharps, the correct management ofwaste which can be anything from soiled bed pads to household waste.

Each of these elements is now explored in more detail on this DVD. After watching each program you should carry out the task and activities in your workbook. This will help strengthen your learning and enhance your skills and knowledge around infection prevention and control.

Chapter 5.1 – Hand Hygiene


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Hand hygiene was identified in the 19th century as an important tool in the fight against infection, and this remains true today. The most common way in which micro-organisms are spread is via people’s hands, which are covered ina range of microscopic life forms. Many micro-organisms are harmless but some can cause illnesses such as diarrhoea and vomiting. Good effective hand hygiene is the single most important thing that you can do to prevent thespread of infections and help protect those you care for, as well as visitors, colleagues, your family, and yourself.

If your hands are not visibly dirty or soiled, you should clean them using an alcohol based hand rub. If your hands are visibly soiled, or you’ve been caringfor someone with a suspected or known gastrointestinal infection, such as norovirus or clostridium difficile, then you should wash them with liquid soap and warm running water.

These pictures show the impact upon harmful bacteria by using alcohol basedhand rubs alone, and liquid soap and warm running water. You should always carry out hand hygiene at the start of your working day. Throughout the day you will also need to assess each task you undertake for further hand hygienerequirements. It is important for you to think “what am I about to do? What arethe risks? What have I just done? And do I need to carry out hand hygiene?”

There are other occasions when you should always carry out hand hygiene. Before and after attending to someone with their meal. After assisting someone to the toilet. When you have come into contact with any blood and / or body fluids. Before handling, preparing, or eating food. When you have taken off your disposable gloves. Before you leave to go home. This list is not exhaustive, you need to assess when, and whether, there is a risk that your hands have become contaminated and could therefore pass a micro-organismor infection onto the next person you deal with, or the next piece of equipmentyou use.

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The World Health Organisation have defined five moments for hand hygiene, you may see this poster in healthcare premises or in your organisation. When carrying out hand hygiene your hands should be free from stoned rings and wrist jewellery such as bracelets and wristwatches. This is sometimes referredto being bare below the elbow. Nails should be clean and short, with no nail varnish or nail extensions.


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Any cuts, nicks, and abrasions should be covered with a waterproof plaster. Neither alcohol based hand rubs or liquid hand soaps should be topped up, soempty bottles should not be reused. Liquid soap contained within a non-top updispenser is the recommended standard. Bar soap must not be used by staff as it can become contaminated. Disposable paper hand towels are recommended for drying hands. Never use cotton towels that are shared.

Carrying out hand hygiene frequently and properly is easy. Once you have applied the alcohol based hand rub or liquid soap you should remember that the technique used to clean your hands is as important as undertaking it at the appropriate times. To use an alcohol based hand rub properly you should follow this procedure. Apply a palmful of alcohol based hand rub from a dispenser into a cupped hand and cover all surfaces.

Rub your hands together palm to palm. Rub the back of each hand with the palm of the other hand and interlace your fingers. Rub palm to palm with fingers interlaced. Rub the back of your fingers to the opposing palm with fingers interlocked. Rub each thumb in turn, holding it in the opposite hand using a rotational movement. Rub the tips of your fingers in the opposite palm in a circular motion.

Allow your hands to dry naturally, don’t use paper towels. Alcohol based hand rubs and gels must not be used when hands are visibly soiled and dirty, dealing with someone with diarrhoea and/or vomiting, after and contact with blood and / or body fluids , during any outbreaks of norovirus or clostridium difficile. In all of these cases hands must be washed using liquid soap and warm running water. When using liquid soap and warm running water wet your hands with warm running water using a mixer tap, if possible.

Apply liquid soap from a dispenser and cover all of your hands to create a lather. Rub your hands palm to palm. Rub the back of each hand with the palm of the other hand and interlace your fingers. Rub palm to palm with fingers interlaced.

Rub the back of your fingers to the opposing palm with fingers interlocked. Rub each thumb in turn, holding it in the opposite hand using a rotational movement. Rub the tips of your fingers in the opposite palm in a circular motion.

Rinse your hands with running water. Turn off the taps, if you have long handled taps use your wrists, and if not use a paper towel. Dry your hands


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thoroughly using a paper towel. Dispose of the paper towel in the bin. Ultraviolet light can show the difference between hands that have been washed correctly and those with parts that are commonly missed through casual washing.

Your unit may wish to consider using ultraviolet light equipment as part of the hand hygiene education. Hand creams can protect your skin from drying and chapping. You can use a hand cream when required but only from a pump action dispenser, and never from a communal jar or tube as over time they may become contaminated with bacteria. It’s important to be aware that frequent hand hygiene can lead to issues relating to the health of your skin. If you have any issues in this area you should request a review by your organisation’s occupational health department.

NHS Education for Scotland have also produced a hand dermatitis resource that you may find useful. All staff have a responsibility to encourage people that they care for, family, and carers, to observe good hand hygiene. This includes washing hands before and after eating, after going to the toilet, or after coughing or sneezing. If you’re caring for a person who is bed-bound, beit in their own home or in a care setting, it is important to ensure that they have the opportunity to perform hand hygiene too.

This can be achieved through the use of hand wipes. Staff may also need to direct visitors to a point where they can perform hand hygiene. Remember, hands are covered in micro-organisms even if they look clean. The frequency and the technique are equally important for effective hand hygiene. Jewellery should be limited to a plain band. Nails should be clean and short, with no nailvarnish or nail extensions.

If your hands are visibly soiled, or you’ve been caring for someone with a suspected or known gastrointestinal infection, such as norovirus and clostridium difficile, alcohol based hand rubs alone should not be used , and liquid soap and warm water must be used. Washed hands must be dried thoroughly.

Chapter 5.2 - Personal Protective Equipment

Personal protective equipment, or PPE, is a requirement of health and safety legislation. Correctly used it offers protection both to those you care for and


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yourself. However, if it is used incorrectly, it has the potential to put you and those you care for at risk of infection. PPE is worn in addition to normal work clothes, whether these are your own or a uniform.

Personal protective equipment must be made available for use by all staff andmust also be accompanied with training for its appropriate use. The most common types of PPE are disposable plastic aprons, disposable gloves, face protection such as goggles or visors for the face and fluid resistant masks. When considering what protective clothing might be required in any situation itis necessary for you to carry out a risk assessment.

This means whether the task you are about to perform will give rise to any possibility of contact with blood or other body fluids, and if there is a risk of splashing. For example, if cleaning up a spillage of blood, cleaning equipment, or handling soiled items of clothing then PPE should be worn. When there is no contact likely with blood or body fluid contamination, such asdispensing medicine or helping someone dress, then PPE is not normally required.

Throughout your day you will need to assess on a task by task basis whether any PPE is needed in order to protect you or the person you’re caring for. It is important that the storage of PPE avoids the potential for it to become contaminated. All PPE must be correctly stored in a clean, dry area such as a store room, away from areas of possible contamination, and be readily available in places where the need is likely to be the greatest.

For example, don’t have aprons hanging up behind doors or boxes of gloves sitting on toilet cisterns. If you are delivering care in an individual’s own home it is important to ensure that any PPE left within their household is stored appropriately to avoid contamination, or that you carry it in an appropriate bag. Disposable gloves come in a variety of sizes, and in order to give the maximum protection must be close fitting.

Disposable gloves should be changed for each person you are caring for, and each new task. If gloves are used inappropriately while dealing with the same individual there is the potential for moving and organism from one part of their body where it is doing no harm to another part where it could cause an infection. Don’t carry gloves in your pocket, and never be tempted to wash


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them. Gloves may also be damaged if they come into contact with alcohol based hand rubs or soapy water.

The wearing of gloves is not a substitute for regular hand cleaning, and handsmust be cleaned using alcohol based hand rub after the removal of gloves or with liquid soap and warm running water. Tasks that require disposable glovesmay also require and apron to be worn. As with disposable gloves, aprons should be changed for each person you are caring for, and each new task. Face protection is sometimes needed when there is a risk of splashing to the face, for example when cleaning a piece of equipment that has been contaminated with blood and / or body fluids , or when cleaning a large spill.

It is very important that all PPE is removed and disposed of in a safe way to reduce the risk of cross-contamination. Gloves should be removed first, followed by any apron worn, and finally eye protection if applicable. When youare finished removing all PPE remember that you should always perform handhygiene using an alcohol based hand rub, if appropriate.

The correct procedure for removing gloves is as follows. Grasp the outside of the glove with the opposite gloved hand and peel it off. Hold the removed glove in the gloved hand. Slide the fingers of the ungloved hand under the remaining glove at the wrist. Peel the second glove off over the first glove. Ensure safe disposal of the used gloves in the correct bin, according to the use and any colour coding system.

With aprons you should always assume that the front of your apron is contaminated and remove it safely as follows. Firstly, unfasten or break the ties at the neck, letting the top half of the apron fall. Unfasten or break the tiesat your waist. Now fold or roll your apron into a bundle ensuring that you do not touch the front of your apron. Finally, ensure its safe disposal in the correct bin according to its use.

Face protection is removed by handling only the headband or the sides, then clean and dispose of it according to the manufacturer’s instructions. Where possible, face protection such as visors or goggles should be disposable, but if it is reusable there should be a detailed cleaning schedule available to you. All contaminated items that are not reusable must be disposed of safely into the correct colour coded waste bin. Remember, carry out hand hygiene using an alcohol based hand rub, or wash your hands with liquid soap and warm water after you have finished removing all PPE used.


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Personal protective equipment and training in its use is a requirement of health and safety legislation. The most common types of PPE are gloves, aprons, and face protection. Disposable aprons and disposable gloves are used once only, then discarded in your setting’s colour coded waste system. Use the correct procedures for the wearing and removal of PPE.

Chapter 5.3- Respiratory Hygiene

The aim of good respiratory and cough hygiene is to prevent the transmission of respiratory infections like coughs and colds, but also the kinds of bacteria which may cause more severe illnesses such as pneumonia and tuberculosis.Viruses such as measles and chickenpox are also transmitted through respiratory secretions. The most common mode of transmission is via the aerosols and droplets that leave the body when we cough and sneeze.

They can also spread via a more indirect route such as hand and surface contact. Sneezing is a way in which our body tries to get rid of any harmful microbes and dust that we may have inhaled into our nose by using the mouth, lungs, and chest to blow the irritation away. Coughing is the same reflex action used by the body to clear the lungs and throat. When we cough or sneeze millions of viral or bacterial particles rush out and contaminate the surfaces on which they land, which could include our food our hands.

Using a disposable tissue to cover the nose and mouth in order to trap these harmful microbes, and then disposing of the tissue in the correct bin minimises the risk of transmission. Hand hygiene must be carried out after wiping and blowing the nose, or trapping sneezes and coughs as the virus willremain on the hands and can spread quickly via touch.

The individuals you care for may need assistance to trap these harmful microbes and carry out hand hygiene. Disposable tissues are much more hygienic than cotton handkerchiefs. Tissues should be readily accessible and everyone should be encouraged to use it only once before throwing it away immediately then carrying out hand hygiene. On any occasions when there is not a tissue available, you should cough or sneeze into the crux of your elbow,this is sometimes referred to as giving your cough the elbow.


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Remember, use a disposable tissue to trap your sneeze or cough. Discard disposable tissues immediately after use. Carry out hand hygiene. Encourage and assist others with the adoption of good respiratory hygiene practices. Ensure those you care for also carry out hand hygiene. Keep contaminated hands away from the mucous membranes of the eyes and nose.

Chapter 5.4 – Safe Management of Blood and Body Fluids Spillages

Spillages of this kind are highly unpredictable, and can happen at any time, and in any area within your working environment. All spillages of blood, body fluids, and excreta should be considered to be potentially infectious, and mustbe dealt with immediately by staff trained to undertake this safely. The person witnessing or discovering the spillage should deal with it immediately. This willreduce the risk of exposure to infectious agents, further contamination, or accidents.

Spillages can consist of blood and / or body fluids , for example urine, vomit, or faeces. When a spillage occurs you need to do an assessment of the content of the spillage, for example does it contain blood, urine, vomit, or faeces. The size of the spillage. The material on which the spillage has occurred, for example fabric, vinyl, or metal.

Based on your assessment you then need to take the appropriate action to clean the spillage effectively. PPE of disposable gloves and an apron must be worn when dealing with all blood or body fluid spillages. This is to prevent skinexposure or contamination of clothing. Face protection may also be needed if it is suspected that there will be splashes to the eyes or mouth. Remember that any waste must be discarded into the correct coloured waste bag at the end of cleaning.

For blood spillage and body fluid spillages with visible blood a kit may be available to you which should contain a range of products. If there is no kit


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available you will require a disposable bag, disposable paper towels, and the appropriate cleaning solution depending on what the spillage is and the type of surface that’s to be cleaned. Within healthcare chlorine based agents are used to decontaminate blood spillage and other body fluid spillage with blood. This may be similar to your place of work. You must check your local policy forcleaning of blood and body fluid spillage including the type of cleaning agent or disinfectant to use, and follow manufacturer’s instructions for use.

If you use chlorine releasing granules or solutions it is important to ensure the area is well ventilated by opening windows and doors. If the spillage involves blood and / or body fluids ensure the correct PPE is worn, and then apply chlorine releasing granules or solution to the spillage.

Also make sure that the spillage is completely covered and saturated. The manufacturer’s instructions should be followed to ensure the correct strength of solution is used for the correct time. This is usually three minutes. If cleaning a blood spillage use a solution of 10,000 parts per million available chlorine. Then place disposable paper towels over the spillage. Next, clean it up using paper towels. Now, place these into a waste bag. Then wash the area with detergent and warm water and place into the waste bag.

If the spillage is on a carpet or soft furnishings and is heavily decontaminated you may have to discard. If the furnishing can withstand a chlorine releasingsolution then follow the appropriate procedure for the type of spill. Alternatively if it is safe to clean with detergent alone follow your local procedures however if not safe to clean with detergent the item should be discarded

. If the spillage you are cleaning is urine, vomit, or faeces, without visible blood first remove any gross contamination, for example vomit or urine, with disposable paper towels. Then apply a solution of 1000 parts per million available chlorine releasing agents.

Follow the manufacturer’s instructions for contact time, or leave it for three minutes. Then use disposable paper towels to clear the area and discard these as waste in the appropriate manner. Note that the strength of chlorine used will differ for spillages of blood and / or body fluids so you must always check manufacturer’s instructions.

When you are finished, discard your PPE and carry out hand hygiene. Remember, deal with all spillages immediately. Use protective clothing as


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required. Follow your local policy for decontamination of blood and body fluid spillages. If using chlorine based products always ventilate the room in advance. Do not use chlorine based products directly on a urine spillage.

Dispose of all used items in the correct waste container. Carry out hand hygiene upon completion.


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Chapter 5.5 Occupational Exposure Management

During your working day it’s possible that the provision of care may expose you to items or substances that have the potential to be harmful. The standardinfection control precautions are the steps you must take to minimise the risk to yourself and to those you provide care. Occupational safety and exposure management involves several aspects. Skin care.

Intact skin is one of our biggest barriers against infection, that’s why it’s important that you cover any breaks in your skin with a waterproof covering. If you or one of your colleagues has a skin condition that may be affected by work, or it has the potential to affect those you care for then medical advice must be sought from your GP or occupational health department. An example of this would be Methicillin-resistant Staphylococcus aureus, commonly referred to as MRSA, and Panton-Valentine leucocidin staphylococcus aureus, referred to as PVLA staphylococcus aureus.

Blood borne viruses. The transmission of a blood borne virus is considered to be a potential occupational risk when delivering care . The greatest risk of a blood borne virus being transmitted is from a sharps injury, especially an injury from a used hollow bore needle that may still contain some blood in it.

Transmission of blood borne viruses may also occur from contamination of themucous membranes due to splashes of blood or body fluids. Significant occupational exposures are injurys sustained from used needles or bites that break the skin, and uncovered broken skin such as abrasions, cuts, or eczema, mucous membranes, including the eyes being splashed with blood or another body fluid.

Sharps. Sharps include items such as needles, blood glucose lancelets, used razor blades, disposable razors, and broken glass. Basically, anything that can cut or puncture the skin, and may be contaminated with blood or other body fluids. It is the responsibility of the person using a sharp to dispose of it correctly and safely. And when using a sharp ensure that you wear the appropriate PPE.

Never leave needles or sharps lying around. Always request assistance when using sharps with an uncooperative individual. Never walk around with unguarded sharps. Do not pass an exposed sharp to another person. Used


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sharps must not be re-sheathed and must be discarded directly into a sharps container. A sharps container must not be filled above the mark that indicates it is full, which is no more than three quarters. Never attempt to push any sharp item that protrudes from the container. Never attempt to retrieve any item from a sharps container.

The sharps container should be taken to where the procedure is taking place, and the sharp immediately disposed of after use. The sharps container must not be placed on the floor, and a temporary closure mechanism must be activated when not in use. Even with the greatest of care accidents do sometimes happen, with the potential for transferring bacteria and viruses.

Should an injury occur, whether it’s a needle stick injury, a cut caused by a razor, or a bite that breaks the skin, you should act immediately. Ensure the item that caused the injury is disposed of safely. Encourage the wound to bleed by gently squeezing the surrounding skin. Do not suck the wound or shake it. Gently wash the wound under warm running water with ordinary liquid soap. gently dry and cover it with a waterproof dressing.

If the eyes are contaminated, irrigate them with either normal saline or runningwater. If you are wearing contact lenses, remove these first before you irrigate. Contaminated mucous membranes, for example the nose or mouth, should be rinsed out with plenty of water. Do not swallow the water, instead spit it out carefully into a sink. Report the injury to the person in charge.

You should always remember to follow the safe use and disposal of sharp items precautions. Always take the sharps container to where you perform theprocedure. Remember to find out where your eye or mouth washout kits are stored. Enquire whether Hepatitis B vaccination is available to you. Adhere to your local reporting systems following all incidents or injury.

Chapter 5.6 – Safe Management of the Care_Environment

Your work setting will influence the way you control your working environment.For instance, infection prevention and control can be very difficult to achieve in an individual’s own home as it is primarily their environment to control. However, you can influence an individual to make changes in their


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environment which will assist with infection prevention. Dust and dirt can allowmicro-organisms to multiply and spread, effective cleaning is therefore essential.

Cleaning and the maintenance of high standards of cleanliness is not solely the responsibility of cleaning or housekeeping staff. All staff are responsible for a clean and tidy environment, and must participate in this important aspectof infection prevention and control. Within care home settings or community based units all staff should be aware of an established cleaning schedule that they must follow and record their cleaning work against.

A signed cleaning schedule provides evidence that cleaning has been undertaken as prescribed and that relevant staff are carrying it out to the standard required. Designated persons should review completed schedules toensure that cleaning is being completed, or to highlight what needs to be prioritised if something has been omitted, for example, it may not be convenient to clean a room on a scheduled day. The schedule should detail furnishings, fittings, curtains, blinds, and flooring, including whether it’s carpet or vinyl.

It’s also important that it covers frequently touched surfaces and objects such as door handles, handrails, and television remote controls. It should also confirm the frequency of cleaning required for each area, the method of cleaning needed, and any cleaning solutions necessary for the task. Throughout your working environment surfaces should be smooth and intact with no visible cracks that can harbour bacteria.

Damaged items should be considered for a replacement, and staff must be trained to safely clean up spillages, in particular blood and / or body fluids . Allcleaning equipment for different areas must always be fit for purpose, regularly maintained, cleaned thoroughly after use, and stored separately to avoid cross-contamination. Mop heads should either be disposable or changed every day and laundered. Thorough cleaning with detergent and hot water is the most effective method for dealing with contamination.

When doing so remember, wear protective clothing, an apron and gloves. Prepare a fresh solution of general purpose neutral detergent in warm water within a small bowl. This should be changed when dirty. Make up only the quantity required, following the manufacturer’s instructions, in a clean, dry container. Dispose of cleaning solution promptly in a sluice or dirty utility area.


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Ensure that equipment is stored clean, dry, and in the designated place. Remove protective clothing and remember to perform hand hygiene.

Cleaning solutions must be locked away when not in use to comply with the regulations for the control of substances hazardous to health, or COSHH. Thisis part of health and safety at work legislation. Solutions made up and stored within a receptacle must be labelled with the solution’s name, the date and time it was made up, and an expiry date. .Avoid using refillable spray cleanersas they provide a breeding ground for micro-organisms if they are not managed properly.

Do not use antiseptics or hand hygiene agents for any cleaning task. In some circumstances other cleaning agents may be needed. If so, always follow the manufacturer’s instructions and wear the appropriate personal protective equipment. Remember, always maintain a clutter-free and clean environment to prevent infection. Cleaning equipment must be clean, fit for purpose, and regularly maintained.

Cleaning schedules should be known to all staff. Freshly made detergent solutions should be used for each task and changed when dirty. Comply with the COSHH regulations.

Chapter 5.7 – Safe Management of Care Equipment

There are many items of equipment used in the delivery of care, and they will require regular cleaning and maintenance to prevent and control the risk of infection. In general, all equipment must be clean, fit for purpose, and in a good state of repair. It must be stored in an appropriate area. Before purchasing any new equipment obtain information from the manufacturer about cleaning and decontamination recommendations to be sure that you can implement them

If there are items of equipment that are not cleaned on a daily basis these should still be part of a written cleaning schedule with records kept as to whentheir cleaning is undertaken, for example, with mattresses and their covers. Care equipment can generally be categorised as follows. Single use equipment is used once on a single person and then discarded.


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It must never be reused, even on the same person. Equipment that falls into this category includes dressing packs and syringes. Packaging for such items will be identifiable with a single use symbol. Single patient use equipment can be reused on the same person. For example, an oxygen or nebuliser mask. Reusable non-invasive equipment, often referred to as communal or multi-useequipment includes mattresses, bed frames, wheelchairs, and walking frames.

As with the general environment, it is important that there is a cleaning schedule that details what equipment is to be cleaned, when to do so, and any cleaning solutions to be used. In the fight to prevent and control the spread of infection keeping care equipment clean, fit for purpose, and well maintained is everyone’s responsibility.

Some pieces of care equipment such as hoist slings are designated for use bya named individual, and should not be used by any other person. The cleaning of these items should adhere to manufacturer’s guidelines unless themanufacturer’s guidance on cleaning and decontamination have been followed. Commodes are used in a variety of settings and are an example of multi-use equipment. They must be cleaned thoroughly between use and between users.

It’s also important to remember to clean the arms, top, and the upper seat of the commode. When it comes to care equipment remember you should be aware of which items are single use and should be discarded, and those that are multi-use and need to be cleaned. Cleaning and maintaining equipment is the responsibility of all staff. You should have a good understanding of cleaning procedures and schedules.

Always read and follow manufacturer’s guidelines, especially when dealing with electronic equipment. Always wear appropriate PPE. Carry out hand hygiene after every task, and the removal of PPE.

Chapter 5.8 - Patient Placement ( for those you care for)

When an individual is found or thought to be suffering from an infection it’s necessary to consider the possible source and route of transmission in order


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to institute appropriate control measures. These may include isolating an individual from others within a care home or community based unit. You might consider such a precaution to be irrelevant in an individual’s home. However, if you are attending to an individual with an illness such as norovirus infection or clostridium difficile infection there is the potential to isolate the toilet the individual uses if more than one lavatory exists in the house.

Within a care setting it is important to assess an individual for any infection risk when they arrive on site, and to continually do so. People who may present an infection risk include those with diarrhoea, vomiting, or an unexplained rash, fever, or respiratory symptoms.

Those known to have been previously positive with a multi-drug resistant organism, for example MRSA, Carbapenemase-producing Enterobacteriaceae, usually referred to as CPE. And those who have been hospitalised outside Scotland in the last twelve months. There are a wide range of infections and conditions that may require individuals to be separatedfrom others. Such isolation is undertaken for two main reasons, to prevent thetransmission of infection from the affected individual to others.

and to prevent the transmission of infection to others who may be particularly susceptible. Infections can be transmitted through a variety of routes, for example from one part of your body to another, from person to person, from the environment, from food, or even from animals.

People can also become infected through contact, by touching something or someone, by breathing in or swallowing something, via a cut or wound, or through contaminated care equipment such as feeding apparatus. Wherever possible individuals within a care home setting found or thought to be suffering from an infection should be separated in a single room or moved to aroom of their own. Ideally, the room should have its own toilet and hand washing facilities.

In community based units the individual should be isolated from others attending the location until arrangements can be made for them to be taken home. Being isolated from others can be a frightening or frustrating experience, staff should therefore discuss the situation with the individual affected, any person they may currently share a room with, and family and carers, to ensure that everyone understands the importance of preventing


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infection for everyone’s wellbeing. The affected person or their family may not agree with such measures.

While for people with dementia isolation may not be possible or practical. In these cases a risk assessment should be undertaken and a plan developed tominimise the spread of infection. All arrangements, agreements, and plans around isolation should be well documented, and reviewed as the situation develops. Always be aware that infections can spread rapidly and it’s important to report any signs of infection to your manager as soon as possible.

Remember, keep the chain of infection in mind, including how an infection is transmitted and spread. Recognise if someone is ill and report signs and symptoms to your supervisor. After someone has been isolated, reflect on how this was handled and discuss how any problems encountered can be addressed.

Chapter 5.9 – Safe Management of Linen

All linen, bedding, pillows, towels, curtains, as well as individual’s personal clothing should be handled with care, as linen can harbour large numbers of micro-organisms. Whatever your work setting, different categories of linen determine how it should be managed. Linen is categorised as follows.

Clean linen andUsed linen, this is linen that has no visible soiling or has not been used by someone who is known or suspected to have an infection. Infectious linen, this is linen that has been used by an individual who has or is suspected to have an infection, or that is contaminated with blood and/or bodyfluids such as vomit, urine, or blood. Heat label linen, this linen, usually personal clothing, has a label that states a lowered recommended washing temperature.

The incorrect handling, laundering, and storage of clean, used, and infectious linen can pose an infection hazard. Therefore it is essential that all linen and laundry is adequately washed then dried and stored correctly. Within care homes and community based units clean linen should be stored in a clean designated area, preferably an enclosed cupboard. If clean linen is not stored


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in a cupboard then the trolley used for storage must only be used for this purpose, and have a complete waterproof covering that is able to withstand thorough cleaning.

Clean linen must not be stored in bathrooms, uncovered trolleys or on trolleys which go into dirty areas like a sluice room due to the risk of cross-contamination. Any trolley used to transport linen must be clean and free of dust and dirt, and all staff handling the linen must have clean hands. Whatever setting you are working in, used linen must be handled in a manner that protects individuals, staff, and the environment from contamination, and itmust be assessed for contaminants such as blood and / or body fluids .

A disposable apron should be worn when dealing with clean and used linen, with the addition of disposable gloves when dealing with infectious linen. Within care homes and community based units firstly ensure that you have a laundry receptacle available nearby. This will facilitate the disposal of the linenas close to the point of use as possible. Staff should not walk in corridors with bundles of linen under their arms or clutched to their chest.

Within an individual’s own home you may wish to place the linen in a laundry basket or directly into the washing machine, but you can discuss this with the householder. Once you have a laundry receptacle ready remove the used linen by rolling or folding it into a bundle. If the linen is deemed to be infectious or there is faeces or vomit present this should be picked up using apaper towel and disposed of correctly. Used or infectious linen should not be put on the floor, shaken, soaked, or rinsed.

Instead it should be placed in a bundle into the correct laundry bag. Ensure you place the linen in the appropriate colour coded laundry bags, either for used linen, or linen that has been assessed as infectious. Laundry bags must also only be filled to three quarters of their full capacity. Water soluble able laundry bags should be used for linen assessed as being potentially infectious, for example linen soiled with blood, or body fluids, These bags can be put directly into a washing machine. It’s important that these bags are used as directed by their manufacturers as incorrect use can compromise how they function.

You should remove your apron and gloves and carry out hand hygiene before handling any clean linen and completing your task. Heat label linen including many items of personal clothing are normally washed at low temperatures to


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avoid damaging garments. In most circumstances this is sufficient to remove most micro-organisms, particularly in domestic style washers. If you work in a setting that carries out the washing of linen from numerous people the following elements are required.

A designated laundry area used only for that purpose, with separate ventilation, and as far away as possible from anywhere food is prepared. An industrial washing machine with a cold sluice cycle and wash cycle temperatures that comply with disinfection standards. The fitting of accurate thermometers that register true wash temperatures. The professional installation of all machines, with a cover over the drain to prevent aerosol contamination.

An industrial drier to ensure the thorough drying of linen is also recommended. A regular maintenance program and records of checks as evidence of diligence and care. The availability of hand hygiene facilities and changing facilities for staff. The provision of different receptacles for clean anddirty laundry, plus there should be separate areas within the laundry zone to ensure no contact between clean and dirty linen.

Family or friends may make a request to take clothes home to wash, this can normally be done but is not advisable during an outbreak situation within care home settings or where clothes are very dirty or soiled due to the risk of contamination. A leaflet written by Health Protection Scotland and aimed at family carers provides guidance on washing clothes at home. It is available onthe accompanying CD. Remember, clean laundry must be stored in a suitable place. Do not mix clean and dirty laundry.

Ensure a laundry receptacle is close at hand to dispose of used linen. Do not shake, sluice or rinse used or infectious linen. Understand the correct colour coding for laundry in your work setting. Do not overfill laundry bags, they should only ever be three quarters full. Use the correct PPE for handling used laundry. Carry out hand hygiene after all handling of used laundry.


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Chapter 5.10- Safe Management of Waste

The provision of care, wherever it is delivered, often results in the production of waste. This waste includes items such as sharps, used continence products, and wound dressings from individuals, as well as waste generated from people who have or may have an infection, particularly during an outbreak or diarrhoea and vomiting. The safe management of all waste by those involved in its handling, transportation, and processing is an essential part of all health and safety and general good hygiene.

It’s also an area covered by relevant legislation. It’s therefore vital that you comply with waste regulations. Information regarding waste regulations is available on the accompanying CD. The regulations include the management of waste that can be recycled such as glass, paper, plastics, metals, and cardboard. This category of waste is not covered in this program.

The way in which waste is handled will be determined by the arrangements between your working environment and the waste contractor responsible for its uplift. A risk assessment will have been carried out by your managers to determine how the waste can be safely disposed of. The risk assessment will depend on a number of factors such as the volume of waste, and whether the waste is from infected or non-infected individuals. A colour coding system should be in place to help you make the correct choices when disposing of waste.

The safe and effective disposal of waste is your responsibility so you need to be aware of the colour coding system in your area to ensure that you make the right choices. For example, as to whether it is household waste, or waste that requires special handling and disposal. Either way, waste should always be disposed of immediately and as close to its point of origin as possible. There are three main categories of waste, and each has its own colour coding. Bear in mind that the coloured bags in your area may be different, however the same principles will still apply.

Domestic municipal waste, this waste is similar to that from household premises, after the removal of recyclable products. Hygiene waste, such waste contaminated with body fluids is more suited to the offensive or hygieneclassification. This category includes urine bags, incontinence pads, single use bowls, and PPE.


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This waste will have been assessed as offensive but not infected; therefore it is not subject to special requirements in order to prevent infection. These items may be placed in a yellow bag with a black stripe, often referred to as tiger bags, or depending on any local agreement between your organisation and the waste contractor a black bag may be appropriate. If you are providing care in an individual’s own home it is acceptable for small quantities of hygiene waste to be disposed of in the domestic waste stream but in such instances it should be double-bagged.

PPE should also be worn when handling this classification of waste. Hazardous special waste, this category is also often referred to as clinical or infectious waste. It consists of items that are or are likely to be contaminated with infected blood and / or body fluids , possibly from an outbreak of infection. An orange bag or yellow bag is used for this type of waste.

Note that special arrangements are required for people receiving medication or treatment with chemotherapy, or low level radioactive tests. Check your local policy to determine the colour of waste bag or container used for this type of waste. For all hazardous special waste, extra care needs to be taken. You should always wear an apron and gloves if there is a risk of splashes or spills. Waste bags must be strong enough to avoid being ripped, and meet theappropriate approved rating for waste management. The national infection prevention and control manual details the UN approved code that waste bags must meet.

They must be no more than three quarters full, and no more than four kilograms in weight. They should also be securely sealed using the swan neckmethod prior to being taken to a secure holding place before uplift by the contractor. Receptacles or bins for waste should be fit for purpose, a suitable size, and placed in convenient locations. If your organisation is purchasing new receptacles or bins, consider those with a solid design which are fire retardant and front-opening for ease of cleaning.

Waste produced as a direct result of healthcare activities such as technical procedures or injections must be risk assessed and disposed of in sharps boxes. Sharps boxes must be correctly assembled and never be over-filled above the manufacturer’s fill line, or three quarters full. The container must bepuncture resistant and leak proof. Within care home settings or community based units sharps containers must be kept off the floor, away from children and inaccessible to unauthorised persons.


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In an individual’s household you should provide them with this same advice. When a sharps container is first assembled, complete the label on the container. Then when it is three quarters full it must be sealed. The label should then be properly completed and the container must be sent for disposal as clinical waste. When a sharps bin is not in use the temporary closure must be closed over. Boxes should be disposed of every three months, even if not full.

If the container has very little in it, the size in use should be reviewed. Sharps containers should be treated as hazardous special waste and be uplifted appropriately by a contractor, or, if being moved from an individual’s home, betransported in the appropriate container. They must not be placed inside another waste bag. No matter what waste you’ve been handling, or whether you were wearing gloves, hands must be washed immediately afterwards. Remember, different types of waste must be treated differently.

Understand the correct colour code system for waste disposal in your work setting. Wear PPE when dealing with soiled waste. Never overfill bags. Ensure waste that is awaiting uplift by the waste contractor is held in a secure,locked area. Always carry out hand hygiene immediately after handling waste of any kind.

Chapter 6 – Other Preventative Measures

The last century the development and use of antibiotics has revolutionised ourability to treat infections. However, as antibiotics have developed so have resistant organisms. This means that antibiotics are increasingly losing their effectiveness. The more an antibiotic is used the more bacteria becomes resistant to it. Current overuse and misuse of antibiotics in both humans and animals has led to an increase in antimicrobial resistance, and to the major public health issue we are now facing.

On the whole, general knowledge of antimicrobial resistance is poor and is often thought of as a problem only in the hospital setting, which is not the case. Media interest in recent campaigns has helped to raise awareness of the challenges, and has raised the profile of good antibiotic stewardship but we still have more to do, and it is down to all of us to act now.


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Through the work of the Scottish Antimicrobial Prescribing Group, SAPG, great progress has been made in appropriate and responsible prescribing, administering management and monitoring of antibiotic use. There is better recognition of the issues and good stewardship is on the increase. However, itis still apparent that generally there is a real lack of knowledge about the seriousness of the problem. The way to tackle the issue is to ensure that we all take responsibility when prescribing, administering and taking antibiotics and this everyone’s business. This is good antimicrobial stewardship and will reduce resistance to antibiotics.

Many infections are treated by the prescription of antibiotics when they don’t need to be. Antibiotics cannot treat viral infections such as coughs, colds, and flu. To slow down antimicrobial resistance it is important for us all to use, manage, administer, and monitor antibiotics appropriately. NHS Education for Scotland offer a range of learning resources and materials across the health professions and disciplines from resources to use at induction of new staff right through to supporting those who are well established in their roles.

The materials range from short online courses to more in depth case studies of people with infections. They are helping to support the implementation of learning at a national and local level, and looks to build capability and capacityin the service to help tackle this very serious problem. Watch the video on antimicrobial resistance and stewardship to find out why antibiotic resistance is becoming a global public health issue and what resources NHS Education for Scotland have to help support healthcare staff in antimicrobial prescribing,administering, and monitoring.

NHS Education for Scotland host a range of education resources which support the implementation of current legislation, and imunisation further enhance improvements in safety. This information will be of value to those working within the health, social, or voluntary care sectors who have a role in supporting patients or clients and their families.

Thank you for watching this Preventing Infection In Care training programme. We hope you found it informative.

We would like to take the opportunity to thank everyone involved in the production of this programme.


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With thanks to the members of the Health and Social Care HAI Education Advisory group and the preventing infection in care short life working Group comprising representatives from the Care Inspectorate, Scottish Care, Scottish Social Services Commission, Health Protection Scotland and Health Protection Nurse Network for their contribution to the development of this educational resource.

Thanks to NHS Highland for the provision of a care home, learning disability unit and a person’s home which feature in the DVD and for assisting with the scripting and filming.


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Documents

Chapter 0 – Overall - Intro - NES · Chapter 0 – Overall - Intro Infection prevention and control is everybody’s business and an essential part of the delivery of high quality