Infection Prevention and Control

The 5 Moments of Hand Hygiene

Resource: http://www.who.int/gpsc/5may/background/5moments/en/

Hand Washing Technique
Hand washing with non-antimicrobial liquid soap and water should take place when
hands are visibly soiled or dirty or when caring for a patient with suspected or known
gastro-intestinal infection.
Before performing hand hygiene:
Expose forearms
Remove all hand/wrist jewellery
Ensure finger nails are clean, short and that artificial nail products are not
worn
Cover all cuts or abrasions with a waterproof dressing.

Hand washing should take 40-60 seconds

Before undertaking a task or procedure, staff should assess the level of risk and ensure
that the appropriate PPE is worn.

PPE Risk Assessment Tool:

All PPE should be:

1. Located close to the point of use.
2. Stored to prevent contamination in a clean/dry area until required for use (expiry dates must be adhered to).
3. Single-use only items unless specified by the manufacturer.
4. Disposed of after use into the correct waste stream i.e. healthcare waste or domestic waste.
   

Gloves must be:

1. Worn when exposure to blood and/or other body fluids is anticipated/likely.
2. Changed immediately after each patient and/or following completion of a procedure or task.
3. Changed if a perforation or puncture is present or suspected.
4. Appropriate for use and well-fitting to avoid excessive sweating and interference with dexterity.

Double gloving is recommended during some Exposure Prone Procedures (EPPs)
such as when attending major trauma incidents or the initial search of casualties prior to
entering the MTF due to the risk of glove tears from bone and metal fragments and
debris.

Aprons must be:

1. Worn to protect uniform when contamination is anticipated/likely e.g. when in direct care contact with a casualty.
2. Changed between casualties and/or following completion of a procedure or task.

Full body gowns/Fluid repellent coveralls must be:

1. Worn when there is a risk of extensive splashing of blood and/or other body fluids e.g. in the operating theatre.
2. Changed between patients and immediately after completion of a procedure or task.

Eye/face protection (including full face visors) must be:

1. Worn if blood and/or body fluid contamination to the eyes/face is anticipated e.g. by members of the emergency department team during a trauma, surgical theatre team and always during Aerosol Generating Procedures (AGPs).
2. Regular corrective spectacles are not considered eye protection.
3. Issued ballistic glasses should not be used for this task.

Fluid resistant type surgical face masks must be:

1. Worn if splashing or spraying of blood, body fluids, secretions or excretions onto the respiratory mucosa (nose and mouth) is anticipated/likely;
2. Worn to protect patients from the operator as a source of infection e.g. when performing an epidural or inserting a Central Vascular Catheter (CVC);
3. Well-fitting and fit for purpose (fully covering the mouth and nose) (manufacturers’ instructions must be adhered to ensure effective fit/protection); and
4. Removed or changed:
   
   

At the end of a procedure/task;

1. If the integrity of the mask is breached, e.g. from moisture build-up after extended use or from gross contamination with blood or body fluids;
2. In accordance with specific manufacturers’ instructions.

Care equipment is easily contaminated with blood, other body fluids, secretions,
excretions and infectious agents. Consequently, it is easy to transfer infectious agents
from communal equipment during care delivery.

Care equipment is classified as either:

1. Single-use: equipment which is used once on a single patient and then discarded. It must never be reused even on the same patient. Needles and syringes are single-use devices. They should never be used for more than one patient. They should also never be re-used on the same patient or reused
   to draw up additional medication.  Administering medications from a single dose vial or intravenous (IV) bag to multiple patients should not be undertaken.
2. Single patient use - equipment which can be reused on the same patient.
3. Reusable invasive equipment - used once then decontaminated e.g. surgical instruments.
4. Reusable non-invasive equipment - (often referred to as communal equipment) reused on more than one patient following decontamination between each use e.g. commode, patient transfer trolley, patient monitoring equipment.

Before using any sterile equipment check that:

1. The packaging is intact.
2. There are no obvious signs of packaging contamination.
3. The expiry date remains valid.

Decontamination of reusable non-invasive care equipment must be undertaken:

1. Between each use.
2. After blood and/or body fluid contamination.
3. At regular predefined intervals as part of an equipment cleaning protocol.
4. As part of daily user inspection (FMed 373), servicing or repair (FMed 767)
5. Adhere to manufacturers’ guidance for use and decontamination of all care equipment.
6. All reusable non-invasive care equipment must be rinsed and dried following decontamination then stored clean and dry.
7. Decontamination protocols should include responsibility for, frequency of, and method of environmental decontamination.
8. An equipment decontamination status certificate will be required if any item of equipment is being sent for inspection, servicing or repair (FMed 767).

It is the responsibility of the person in charge to ensure that the care environment is safe
for practice (this includes environmental cleanliness/maintenance). The person in
charge must act if this is deficient.

The care environment must be:

1. Visibly clean, free from non-essential items and equipment to facilitate effective cleaning.
2. Well maintained and in a good state of repair.
3. Routinely cleaned in accordance with the IP&C deployed cleaning manual.
4. A fresh solution of general purpose neutral detergent in warm water is recommended for routine cleaning. This should be changed when dirty or at 15 minutes intervals or when changing tasks.
5. Routine disinfection of the environment is not recommended. However, 1,000 parts per million available chlorine (ppm available chlorine (av.cl.)), should be used routinely on sanitary fittings.
6. Staff groups should be aware of their environmental cleaning schedules and be clear on their specific responsibilities.
7. Cleaning protocols should include responsibility for, frequency of, and method of environmental decontamination (See resources for template).

Clean linen

1. Should be stored in a clean, designated area, preferably in an enclosed box.
2. Clean linen that is deemed unfit for re-use e.g. badly torn, should be returned to the QM’s for disposal.

Linen used during patient transfer

Any linen used during patient transfer e.g. blankets, should be decontaminated at the point of destination.

For all used linen (previously known as soiled linen)

Ensure a laundry receptacle is available as close as possible to the point of use for immediate linen deposit.

Do not:

1. Shake or sort linen on removal from beds/trolleys.
2. Place used linen on the floor or any other surfaces e.g. a locker/table top.
3. Re-handle used linen once bagged.
4. Overfill laundry receptacles.
5. Place inappropriate items in the laundry receptacle e.g. used equipment/needles.

For all infectious linen (this mainly applies to healthcare linen) i.e. linen that has been used by a patient who is known or suspected to be infectious and/or linen that is contaminated with blood and/or other body fluids e.g. faeces:

1. Place directly into a water-soluble/alginate bag and secure; then place into a plastic bag e.g. clear bag and secure before placing in a laundry receptacle. This does not apply to any item(s) heavily soiled and unlikely to be fit for reuse. These should be yellow bagged and disposed of as clinical waste. (QM
   should be informed of what and number of items disposed of so replacements can be sought).
2. Used and infectious linen bags/receptacles must be tagged e.g. ward/care area and date.
3. Store all used/infectious linen in a designated, safe, lockable area whilst awaiting transfer to laundry. Local guidance regarding management of linen may be available.

Safe Management of Blood and Body Fluid Spillages

Spillages of blood and other body fluids may transmit blood borne viruses.
Spillages must be decontaminated immediately by staff trained to undertake this safely
using the correct equipment following the manufacturer’s guidance.
Responsibilities for the decontamination of blood and body fluid spillages should be
clear within each area / care setting.
Personnel undertaking the safe management of blood and body fluid spillages must be
Hep B vaccinated and levels checked.

The Health and Safety (Sharp Instruments in Healthcare)  Regulations 2013 outline the
regulatory requirements for employers and contractors in the healthcare sector in
relation to:

1. Arrangements for the safe use and disposal of sharps.
2. Provision of information and training to employees.
3. Investigations and actions required in response to work related sharps
injuries.

Sharps handling must be assessed, kept to a minimum and eliminated if possible with
the use of approved safety devices.
Manufacturer’s instructions for safe use and disposal must be followed.
Needles must not be re-sheathed.
Always dispose of needles and syringes as 1 unit.

Sharps boxes must:

1. Have a dedicated handle.
2. Have a temporary closure mechanism, which must be employed when the
box is not in use.
3. Be disposed of when the manufacturer’s fill line is reached.
4. Be labelled with point of origin and date of closure.

A significant occupational exposure is:

1. A percutaneous injury e.g. injuries from needles, instruments, bone
fragments, shrapnel or bites which break the skin.
2. Exposure of broken skin (abrasions, cuts, eczema, etc.); and/or
3. Exposure of mucous membranes including the eye from splashing of blood or
other high risk body fluids.
There is a potential risk of transmission of a Blood Borne Virus (BBV) from a significant
occupational exposures and staff must understand the actions they should take when a
significant occupational exposure incident occurs.

Immediate Management of Innoculation Injury

Waste Management Guidance (HTM 07-01) contains the regulatory waste management
guidance for Defence including waste classification, segregation, storage, packaging,
transport, treatment and disposal.
The Health and Safety (Sharp Instruments in Healthcare) Regulations 2013 outline the
regulatory requirements for employers and contractors in the healthcare sector in
relation to the safe disposal of sharps.

Categories of waste:

1. Healthcare (including clinical) waste – is produced as a direct result of
healthcare activities e.g. soiled dressings, sharps.

2. Special (or hazardous) waste – arises from the delivery of healthcare in both
clinical and non-clinical settings. Special waste includes a range of controlled
wastes, defined by legislation, which contain dangerous or hazardous
substances e.g. chemicals, pharmaceuticals.

3. Domestic waste – must be segregated at source into:
o Dry recyclates (glass, paper and plastics, metals, cardboard).
o Residual waste (any other domestic waste that cannot be recycled).
Waste Streams:

1. Black – Trivial risk: Domestic waste
 Final disposal to Landfill.
Clear/opaque receptacles may also be used for domestic waste at
care area level.

2. Yellow – High risk:
Waste which poses ethical, highly infectious or contamination risks.
This includes anatomical and human tissue which is recognisable as
body parts, medical devices and sharps waste boxes that have
yellow lids.
Disposal is by specialist incineration.

Safe waste disposal at care area level:
Always dispose of waste:
1. Immediately and as close to the point of use as possible.
2. Into the correct segregated colour coded UN 3291 approved waste bag (either
yellow for healthcare waste or black/clear/opaque for domestic) or container
(sharps box).

Liquid waste - e.g. blood must be rendered safe by adding a self-setting gel or
compound before placing in a healthcare waste bag.

Waste bags - must be no more than 3/4 full or more than 4 kgs in weight; and use a
ratchet tag/or tape (for healthcare waste bags only) using a ‘swan neck’ to close with the
point of origin and date of closure clearly marked on the bag.

Store all waste - in a designated, safe, lockable, pest resistant area whilst awaiting
uplift. Uplift schedules must be acceptable to the care area and there should be no buildup of waste receptacles.

Waste transfer - notes must be completed by the producing unit and signed by both the
producing unit and the person receiving the waste (See Resources).

Sharps boxes must:

1. Have a dedicated handle.
2. Have a temporary closure mechanism, which must be employed when the
box is not in use.
3. Be disposed of when the manufacturer’s fill line is reached.
4. Be labelled with point of origin and date of closure.

Local guidance regarding management of waste at care level may be available