Primary Care Infection Prevention and Control Responsibilities

Mid and South Essex Infection Prevention &

Control Team

Objectives

• Importance of Legislation

• Policies

• Chain of infection

• Healthcare Associated Infection (HCAI)

Legislation • Health and Social Care Act - Code of Practice on

the prevention and control of infections and related guidance, 2008 (updated 2012)

• Code of Practice

• Care Quality Commission

Legislative/ Statutory requirements

• Health and Safety at Work Act 1974 • Control of Substances Hazardous to Health

(COSHH) 2002 • Legionella – Water Risk Assessment (privately

owned premise)

Health & Social Care Act

• Regulation 12, Outcome 8 • Code of Practice for the prevention and control

of healthcare associated infection • Applies to ALL care providers, including NHS

Providers and Independent Contractors • Evidence is required to demonstrate

compliance

Criterion 2 of the Code of Practice levies on providers a specific duty to:

Provide and maintain a clean and appropriate environment in managed premises that facilitates the prevention and control of infections

(Health and Social Care Act 2008 Code of Practice criterion 2)

Code of Practice

Compliance

criterion

What the registered provider will need to demonstrate

1 Systems to manage and monitor the prevention and control of infection. These systems use risk assessments and

consider the susceptibility of service users and any risks that their environment and other users may pose to them.

2 Provide and maintain a clean and appropriate environment in managed premises that facilitates the prevention and

control of infections.

3 Ensure appropriate antimicrobial use to optimise patient outcomes and to reduce the risk of adverse events and

antimicrobial resistance.

4 Provide suitable accurate information on infections to service users, their visitors and any person concerned with

providing further support or nursing/ medical care in a timely fashion.

5 Ensure prompt identification of people who have or are at risk of developing an infection so that they receive timely and

appropriate treatment to reduce the risk of transmitting infection to other people.

6 Systems to ensure that all care workers (including contractors and volunteers) are aware of and discharge their

responsibilities in the process of preventing and controlling infection.

7 Provide or secure adequate isolation facilities.

8 Secure adequate access to laboratory support as appropriate.

9 Have and adhere to policies, designed for the individual’s care and provider organisations that will help to prevent and

control infections.

10 Providers have a system in place to manage the occupational health needs and obligations of staff in relation to infection.

Care Quality Commission • Health and social care regulatory body for

England • Monitoring and inspection of ALL health and

social care providers • Using enforcements such as fines, closures of

services, special measures • Reporting findings and outcomes to the public

about the services they access

Service requirement

It is your responsibility to provide evidence to demonstrate compliance to the Health and Social Care Act - Code of Practice Identify an infection control link worker within the team to support this

Policies

• What is needed? • Where are they? • Have you read them?

IPC related policies

• IPC – overarching with separate procedural guidelines or all encompassing? i.e. hand hygiene, sharps, waste, HCAI etc.

• Programme defining the infection prevention and control assurance framework/ infrastructure

• Local protocol for vaccine management (cold chain) available (MMT)

What is Infection Prevention and Control?

BASIC COMMON SENSE

Essential part of all health/social care practice

Based on the principles of microbiology

The Chain of Infection

Source Mode

of Spread

Portal of

Entry

Person at

Risk

Modes of Spread

Direct contact Hands Inhalation Ingestion Inoculation Skin to skin

Indirect contact Hands Inanimate objects Vectors (crawling or flying insects)

Healthcare Associated Infection

MRSA Clostridioides difficile

Meticillin / Multi Resistant Staphylococcus Aureus

• Post infection review (PIR)

• Changes in the enteric flora induced by antibiotics may produce acute diarrhoea by overgrowth and toxin production by C. diff

• A spore-producing organism can heavily contaminate the environment

• Root Cause Analysis (RCA)

Flag on SystmOne!

Antimicrobial Stewardship • Antimicrobial Resistance: main driver

• Monitoring appropriateness of antimicrobial prescribing

• Improve patient outcomes

• Criterion 3: Code of Practice

• Led by CCG Medicines Management

Vision Statement: The Health and care experience of the people of Thurrock will be improved as a result of our working effectively together.

• IPC Standard Principles (Universal Precautions)

• Environmental Cleaning

• Minor ops rooms

Standard Principles of IPC (Universal Precautions)

• Hand-washing/skin care

• Protective Clothing

• Safe handling of sharps (sharps injury management)

• Body Fluid spillage management

Hand Hygiene

• Dedicated hand hygiene sinks (htm64 compliant?)

• Hand washing technique posters at all sinks

• Soap, paper towel dispensers, hand gel, hand cream

• Audit – how do you know staff are compliant?

Personal Protective Clothing (PPE) • Aprons Disposable, plastic, good barrier, cost effective, for protecting skin and preventing soiling of clothing

• Eye protection and *masks/visors For protecting mucous membranes of eyes, nose and mouth

*Danger of aerosol / splashes of body fluids, blood or excretions

Adequate supplies and dispensers?

Sharps Management (Inc. sharps injury)

• Sharps Management Risk Assessment • EU DIRECTIVE 2010/32/EU - safe sharps • Appropriately coloured lids • Labelling • When to discard bins • Temporary closure mechanism/Placement • Sharps injury management – what

arrangements are in place? • Incident reporting!

Body fluid spillage management • Spillage kits or wipes • Process for cleaning • Appropriately trained staff

Why?

• Bloodborne virus! Human Immunodeficiency virus (HIV)

Hepatitis B + C

• Norovirus, C.diff etc.

Environmental Cleaning

Why is environmental cleaning so important?

• The environment harbours micro organisms that cannot be seen

• Organisms such as MRSA can survive in dust for up to 80 days

• C.diff spores can survive in the environment for years!

Control Measures

• Cleaning schedules/checklists – environmental and clinical equipment

• Body fluid spillage management

Expert Guidance

• Colour coding

Expert Guidance

• Audit – who, how, when?

Cleaning considerations

• Limescale i.e. taps, showerheads, sink area

• Toys – regular cleaning schedule, appropriate storage

• Privacy curtains - Disposable or washable? How often?

• Keyboard covers

• Condition of the environment i.e. damaged walls, flooring, treatment couches, chairs (including waiting rooms)

Guidance • The national specifications for cleanliness in the

NHS, 2010:Guidance on setting and measuring performance outcomes in primary care medical and dental premises Appendices 1-10 give guidance on what is needed

• Health Building Note 00-09, 2013: Infection control in the built environment

• Health Building Note 00-10 Part C: Sanitary assemblies DH 2013

Cleaning cupboards

• Clean and tidy!

• Clean equipment

• Evidence of colour coding

• Cleaning Schedules

• PPE

• COSHH data sheets

Good versus Bad

Cleaning equipment

Dirty/damaged equipment

Clinical Equipment Cleaning

• Clinicians responsibility!

• Evidence of regular cleaning

• Planned Preventative Maintenance for general equipment

(certificate if sending off??)

Minor ops rooms

• Fit for purpose room

• Walls, flooring, ceiling

• Air changes??

• Curtains

• Sterile equipment stock checks/rotation

• No clutter or inappropriate items

• Waste management

• Water management

• IPC training

• EVIDENCE

• Audit

Waste Management

HTM 07-01- Safe management of healthcare waste

• Risk assessment for the management of healthcare waste

• Waste consignment notes for the transportation of hazardous wastes

Classification of waste

• Clinical (hazardous)

• Tiger stripe (offensive)

• Domestic

• Recycling

• Confidential

• Colour coded bins (fire resistant)

External clinical waste bin

Water Management

Health Technical Memorandum (htm)07-04:

Water management and water efficiency – best practice advice for the healthcare sector IPC considerations: Legionella / Pseudomonas Tap flushing (unused or infrequently used outlets)

Water Risk Assessments - who does them?

IPC training Expert Guidance Code of Practice for the prevention and control of infections 2015 Criteria 1, 2, 6 and 10; NICE clinical guideline 139 Infection - Prevention and control of healthcare associated infections in primary and community care NICE 2012 Where to source Who should attend? Record of training

Evidence Relevant policies/protocols

Risk assessments

IPC training records

Cleaning schedules (environmental and clinical equipment)

Clinell green stickers?

Audit data

Audit

Annual IPC Environmental

Waste – annual

Environmental Cleaning – Weekly (minor ops), Monthly, bi-monthly

Clinical equipment cleaning schedules

Hand hygiene (is this captured in patient surveys? – how often?)

GP Information/Guidance

IPC Policy Principles and NICE IPC Guidelines

Code of Practice Criteria

GP Surgery Health Centre Practice Improvement Tool

MRSA Guidance and Primary Care Guidance for High Risk MRSA Management

Clostridioides difficile Policy Principles