Infection Control Policy

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					   INFECTION CONTROL POLICY




Date Agreed by Board                   August      2003
Reviewed                              September 2004
Lead Director                Director of Public Health
Lead Manager Clinical Nurse Specialist Infection Control




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                    Infection Control Policy
This Infection Control policy needs to be read in conjunction with the
         Infection Control guidelines issued in August 2003.

1     Infection Control Policy_____________________________________ 4
    1.1    Principles ____________________________________________ 4
    1.2    Responsibilities _______________________________________ 5
    1.3    Infection Control and the Law ____________________________ 5
2     Standard Universal Infection Control Procedures _______________ 7
    2.1    Hand washing _________________________________________ 7
      2.1.1   Aim ______________________________________________ 7
      2.1.2   Definition __________________________________________ 7
      2.1.3   Routine hand washing ________________________________ 8
      2.1.4   Surgical hand washing _______________________________ 8
      2.1.5   Requirements ______________________________________ 8
      2.1.6   How to wash your hands ______________________________ 9
    2.2    Skin Care _____________________________________________ 9
      2.2.1    Jewellery __________________________________________ 9
      2.2.2    Fingernails ________________________________________ 10
    2.3    Protective Clothing ____________________________________ 10
    2.4    Gloves ______________________________________________ 10
      2.4.1    Latex sensitivity (see Latex Policy) _____________________ 10
      2.4.2    High-risk populations ________________________________ 11
    2.5    Eye Protection and Masks ______________________________ 11
    2.6    Water-repellent Disposable Aprons or Gowns _____________ 12
    2.7    Sharps management __________________________________ 12
      2.7.1   In the home 'coke' type containers must not be used. _______ 12
      2.7.2   Key points for safe disposal ___________________________ 13
      2.7.3   Sharps containers __________________________________ 13
      2.7.4   Sharps Injuries/Splashing Injuries ______________________ 13
      2.7.5   Splashes to Broken Skin or Mucous Membranes __________ 14
    2.8    Safe Injection Technique _______________________________ 14
    2.9    Spillage Management __________________________________ 15
    2.10   Specimen Handling ___________________________________ 15
    2.11   Vaccines ____________________________________________ 16
    2.12 Disposal of Waste/Clinical Waste Management _____________ 17
      2.12.1 Clinical Waste _____________________________________ 17
      2.12.2 Sharps ___________________________________________ 18
      2.12.3 Non-Clinical Waste _________________________________ 18
      2.12.4 Storage of Clinical Waste ____________________________ 18
      2.12.5 Transport of Clinical Waste ___________________________ 18


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2.13 Routine Equipment Decontamination _____________________ 19
  2.13.1 Cleaning _________________________________________ 19
  2.13.2 Disinfection _______________________________________ 20
  2.13.3 Sterilisation _______________________________________ 20
  2.13.4 Risk Assessment for Decontamination __________________ 20
  2.13.5 Sterilisation _______________________________________ 21
  2.13.6 Decontamination of Health Care Equipment Prior to Inspection,
  Service or Repair __________________________________________ 23
2.14 Environmental Hygiene ________________________________ 24
  2.14.1 Clinical Areas _____________________________________ 24
2.15   A Brief Guide to Cleaning and Disinfecting Agents _________ 25
2.16   Notification of Infectious Disease ___________________________ 26
2.17   REFERENCES ________________________________________ 27




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1     Infection Control Policy
Croydon PCT is fully committed to the minimisation of risk of cross infection to
staff, patients and visitors in the course of its work. The Trust expects staff or its
representatives to take responsibility and practise safely to prevent the
transmission of infection within the community.

Croydon PCT Infection Service aims to provide a safe environment of care for all
and to promote awareness of the importance of preventing Infection.

References at to be found end of the policy.


1.1    Principles

   This policy aims to minimise the number and severity of cross infection
    throughout the Trust.

   This policy aims to provide a safe environment for all health care workers,
    clients, staff and visitors.

   This policy and the guidelines therefore are intended to set out procedures to
    be followed and to act as a reference for giving advice to staff, patient clients
    and others.

   Adherence to procedures and the philosophy implicit in it is a requirement for
    all staff, contractors and agency staff. It should therefore be brought to the
    attention of anyone working for or on behalf of the Trust.

   This Policy and its accompanying guidelines should be drawn to the attention
    of all new staff as part of their induction.

   Although staff may have to work in less than ideal environments, safe,
    standards and practice must be maintained at the highest level obtainable in
    that individual environment.

   All staff and contractors must receive adequate training in infection control
    relevant to their individual responsibilities and job content, prior to taking on
    those tasks.


The prevention of acquired infection depends upon the application of science and
logic. Unfortunately this is often forgotten in today's stressful environment and
the omission of the most important preventive measure is forgotten -
HANDWASHING.




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1.2    Responsibilities

The Chief Executive (Ms Caroline Taylor) has the ultimate responsibility for
ensuring that there are effective arrangements for infection control within the
Trust.

The Infection Control Committee has responsibility for infection control within the
PCT.

Infection Control Advice can be obtained from the Clinical Nurse Specialist
Infection Control (Penny Spence) based at Knollys House.

Penny Spence
Tel: 0208 274 6009
Mobile: 07867556236
E Mail: penny.spence@croydonpct.nhs.uk


1.3    Infection Control and the Law


Please read in conjunction with the Croydon PCT Health and Safety Policy

The importance of minimising risks of infection and the control of hazardous
practices is clearly laid out in the Health and Safety at Work Act (1974), the
Health and Safety at Work regulations (1992) and the Control of Substances
Hazardous to Health (COSHH) Regulations (1999).

Health and Safety at Work Regulations (1992)

Requires employers to assess the risk to their employees' health and to put in
place control measures. In relation to infection control, it is the employer's
responsibility to ensure that staff are protected from exposure to infectious
hazards through the provision of safe systems of work.

The Control of Substances Hazardous to Health Regulations (1999)

Offers specific guidance regarding protection against hazardous substances,
including chemicals and biological agents in the workplace. The employer is
responsible for ensuring that guidance and policies are in place and that these
are implemented regularly reviewed and updated.

It also requires that potentially infectious biological agents leaving the clinical
environment, such as clinical waste and pathology specimens, be packaged in
accordance with current guidance to prevent accidental exposure to persons
outside the clinical environment.




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The Health and Safety at Work Act (1974)

Requires employers to provide, as far as is reasonably practicable, a safe
environment not only for employees, but all persons visiting the site. It requires
employees to take reasonable precautions to ensure their safety and the safety of
others. These include:
 Personal protective clothing
 Hand washing facilities
 Systems for the management of used instruments
 Systems for the safe disposal of waste
 Systems for the safe handling, storage and carriage of specimens

The Provision and Use of Work Equipment Regulations 1998 (PUWER)

Requires the employer to ensure that work equipment is suitable for the intended
purpose and is safe to use. Equipment must be maintained in a safe condition
and inspected periodically to ensure that it remains safe. Only people who have
received adequate information, instruction and training must use it.

The Pressure Systems Safety Regulations 2000 (PSSR).
These regulations apply to bench top steam sterilises. Steam is particularly
hazardous and these regulations are intended to minimise the risks.
The main hazards are contact with steam and impact from parts:
 Proper maintenance
 Periodic examination of the pressure system by an authorised engineer.
 Suitable training for the operators.




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2     Standard Universal Infection Control Procedures
Each member of staff is accountable for his/her actions and must follow safe
practices.

Standard Infection Control Precautions are the group of precautions which aim to
break the process by which an Infection occurs. The process is that there has to
be a source or reservoir of the bacteria, virus or other organism that can cause
an Infection and there also has to be a vector or means of Transmission and a
susceptible host.

Blood and body fluids may contain blood-borne viruses (e.g. Hepatitis B+C, HIV)
or other bacterial and viral pathogens. As it is impossible to determine the status
of who is infected with these pathogens all blood and body fluids are treated. As
potentially Infectious and Universal precautions must always be taken when
dealing with blood and body fluids this then also ensures the person’s right to
confidentiality is respected and maintained.

Universal precautions apply to all patients /clients where there is possible contact
with:
 Blood
 Body fluids
 Non-intact skin
 Mucous membranes
.

2.1     Hand washing

2.1.1    Aim

To prevent ―nosocomial infection‖ caused by an organism from another person
either directly or indirectly (cross infection) by means of another person’s hands.


2.1.2    Definition

Cross infection is most commonly spread by contaminated hands. Some bacteria
will inhabit and multiply on the skin: these are known as resident flora or
commensals. Others will be picked up by contact and passed on by contact:
these are known as transient micro organisms. It’s the transient organisms which
are potentially Infectious

Hand hygiene is the single most important factor in the prevention of cross-
infection.

Hand washing can be categorised into two types routine and surgical.




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2.1.3    Routine hand washing

Routine hand washing removes dirt, organic material and most transient micro
organisms found on the hands. A 10-15 second hand wash using the correct
procedure (see guidelines for technique), clean liquid soap, and dry disposable
paper towels is adequate for this purpose.

   Remove wristwatches, jewellery and roll up/remove long sleeved clothing
   Wet hands under warm running water and apply liquid soap into cupped hand
   Wash all parts of the hands thoroughly for 10-15 seconds
   Rinse hands thoroughly under running water
   Dry hands with disposable paper towel.


2.1.4    Surgical hand washing

Surgical hand washing destroys transient organisms and reduces resident flora
This procedure is only required as a pre-operative scrub before surgical or
invasive procedures Using the same correct routine hand washing technique, an
aqueous antiseptic solution is applied for two minutes.
The wearing of gloves is NOT a substitute for hand washing.

Hands should be washed:
There is no set frequency, as hands should be washed when necessary, not as
routine. The following are some examples of when hands should be washed ..
 Whenever hands become visibly soiled e.g. bodily fluid.
 Before and after physical contact with each client.
 After handling contaminated items such as dressings, bedpans, urinals and
   urine drainage bags.
 Before putting on and before and after removing protective clothing including
   gloves.
 After using the toilet or toileting others, blowing your nose, covering a sneeze.
 Before eating, drinking or handling food and before and after smoking.

 Before and after giving direct patient care and aseptic procedures

 Before and after each work shift or work break. Remove jewellery (rings).

 After disposing of rubbish both clinical and domestic.

2.1.5    Requirements

   Easily accessible sinks.
   Hot and cold water (preferably with mixer taps).
   Preferably elbow, wrist or sensor operated taps to reduce the risk of hand
    contamination.
   Liquid soap (with disposable not refillable cartridges). Refillable cartridges can
    become contaminated with micro-organisms during the 'topping up' process.
   Soap bars are not suitable for use in the multi use setting as they easily
    become colonised with Gram-negative bacteria and Pseudomonas spp. and
    can therefore act as a source for cross-infection.
   Wall mounted disposable paper towels. Re-usable towels are not suitable for


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    multi use settings as they become readily contaminated with micro-organisms
    and are therefore a potential source of cross infection.
   Nailbrushes are not usually indicated for hand hygiene in practice. If needed,
    a sterile (single use) brush should be used on each occasion.
   Foot operated Bins for disposal of paper hand towels.


2.1.6     How to wash your hands

        Method                    Solution                    Task
1       Social (10-15 ) secs      Liquid Soap                 For all routine tasks
3       Surgical scrubs (2 mins.) Antiseptics, e.g. Hydrex,   Prior to surgical and
                                  thorough and careful.       other invasive
                                  Dry on sterile towels.      procedures.



2.1.7     Alcohol hand rub/gel
70% Alcohol hand rub/gel must only be used on visibly clean hands as evidence
has shown that the alcohol does not penetrate organic matter dirt/grime.

In areas where hand washing facilities are not available and provided the hands
have been washed and are physically clean, a 70% alcoholic hand gel /rub
containing an emollient is effective.

Alcohol hand rub should be used if working in a high-risk area, involved in an
outbreak of infection, or where there are no suitable hand washing facilities.
USE ALCOHOL GEL ONLY ON VISIBLY CLEAN HANDS

2.2     Skin Care

Bacterial counts increase when the skin is damaged so it is important all cuts and
abrasions must be covered with a waterproof dressing. Blue dressings must be
used by those involved in food preparation.

Regular use aqueous of hand cream may help to prevent skin damage. DO NOT
use multi-use pots of cream, as these become contaminated.


2.2.1     Jewellery

Jewellery and wristwatches must not be worn. A wedding ring is permitted,
however great care must be taken to make sure that the finger under the ring is
thoroughly dried.




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2.2.2    Fingernails

Fingernails must be kept clean, short and smooth. When hands are viewed from
palm side, no nail should be visible beyond the fingertip. Nail Varnish must not
be worn.

2.3     Protective Clothing

Disposable Aprons and gloves must always be worn when handling excreta,
blood and body fluids.

The choice of protective clothing selected depends on the anticipated risk of
exposure to blood and body fluid during the particular activity. Many clinical
activities involve no direct contact with body fluid and do not require the use of
protective clothing; for example: washing a patient or taking a pulse, blood
pressure or temperature.

Other procedures may result in contamination of the hands or clothing and
require the use of gloves, a plastic apron, goggles, face visor, for example
assisting a patient with a commode, handling specimens or during specific
treatment , eg. dental or chiropody treatment.


2.4     Gloves

Disposable gloves must be worn for any activity where blood and body fluid may
contaminate the hands. Hands should be washed after removal of the gloves as
they may be punctured, and because hands are easily contaminated as the
gloves are taken off.

To prevent transmission of infection, gloves must be used once and discarded
after each procedure. Gloves should not be washed between patients as: the
gloves may be damaged by the soap solution and, if punctured unknowingly, may
cause body fluids to remain in direct contact with skin for prolonged periods.

Gloves must not be worn for prolonged periods.

Sterile gloves should only be used when the hand is likely to come into contact
with normally sterile areas of the body; for example: performing surgical
procedures.

General-purpose utility gloves (e.g. rubber household gloves) should be used for
environmental and can be used for cleaning instruments prior to sterilisation, or
when coming in contact with possible contaminated surfaces or items.

2.4.1    Latex sensitivity (see Latex Policy)

– Good Practice – Staff experiencing an allergic reaction to latex must inform the
Occupational Health Department.


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As the use of latex gloves has increased, reports of latex sensitivity amongst
health care workers and patients have risen. The risk of allergic reactions is not
only related to gloves but can involve other latex based devices. Reactions are
classified as:

   Delayed hypersensitivity (type 1V) resulting in contact dermatitis. This is the
    most common hypersensitivity reaction to NRL. Response occurs between 6-
    48 hours after exposure.
   Immediate hypersensitivity (type I) — anaphylactic shock/collapse. Response
    occurs 5-30 minutes after exposure. Individuals with a history of anaphylaxis
    caused by latex must avoid the use of latex gloves and devices.


2.4.2    High-risk populations

The following groups appear to have an increased risk of developing a latex
allergy:

       Individuals with frequent occupational exposure.
       Atopic individuals — those with a predisposition to allergic reactions (e.g.
        hay fever, asthma).
       Individuals with food allergies (e.g. bananas, avocado, tomato and kiwi
        fruit).

Frequent healthcare interventions — individuals with conditions, which require
frequent healthcare interventions, particularly where latex devices are used (e.g.
spina bifida, congenital urological abnormalities or any conditions requiring
repeated surgical interventions).

Seek specialist advice if latex sensitivity is suspected. If the individual is
sensitised, then all notes should be clearly marked (including dental and hospital
notes).

In Type I reactions, the individual should wear a Medic Alert bracelet.


2.5     Eye Protection and Masks

Eye protection and masks are used to protect health care workers from splashes
of body fluid and should be worn for any activity where there is a risk of body fluid
splashing into the face.

Protective eyewear must be made available for staff to use if the planned
procedure is likely to cause splashing of body fluids into the eyes (e.g. certain
minor surgical procedures, manual cleaning of instruments). Eyewear should be
decontaminated according to the manufacturer's instructions.




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In the past, masks were worn with the intention of protecting vulnerable sites on
the patients such as wounds, from contamination by micro organisms expelled
from the respiratory tract of the user. It is now recognised that a healthy member
of staff expels few micro organisms from the respiratory tract and that masks are
not necessary for most procedures.

2.6     Water-repellent Disposable Aprons or Gowns

Water-repellent protection should be worn for procedures anticipated to cause
significant contamination of skin or clothing with blood or body fluid and should be
changed between each patient. This will protect the skin of the health care
worker from contamination by potentially infected body fluid and reduce the risk
of cross-infection of micro-organisms to other patients on the clothing.

Since the front of the body is the part most frequently contaminated by body fluid,
plastic disposable aprons provide adequate protection in most circumstances.
Disposable plastic aprons should be worn when contamination of clothing with
blood and body fluids is anticipated. Plastic aprons should be discarded after
each procedure and between patients and disposed of as clinical waste.

Exposure to body fluid during surgical procedures varies; minor surgery such as
biopsy or lump removal, which involves little exposure to body fluid requires a
disposable apron only.      However, more invasive surgery may result in
considerable contamination with blood or body fluid, then a water-repellent sterile
gown should then be worn.


2..7
27      Sharps management

Please read in conjunction with Inoculation Injury policy
Sharps include needles, scalpels, stitch cutters, glass ampoules and sharp
instruments. The safe handling and disposal of sharps is essential in reducing the
risk of exposure to blood borne viruses. The risk of injury can be minimised by
adhering to accepted good practice.

It is the responsibility of the sharps user to ensure its
safe disposal

2.7.1     In the home 'cola' type containers must not be used.

    Each patient should have their own Sharps container if sharps are going to be
     generated more than once in their home. Collection can be organised by the
     local authority
    - It is the responsibility of the health care worker supplying the container to
     make arrangements for the full sharps box to be returned, or exchanged for a
     new one. This may by collection of the local authority, or at the nearest health
     centre or surgery.



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    Community staff should carry a canister-type container, in the event that it is
    deemed unsafe to leave a sharps container in the client's home. Or for single
    visits.
   Containers must never be left unattended in vehicles and should be stored out
    of sight.


2.7.2    Key points for safe disposal of Sharps

 Never re-sheath needles manually.
 Sharps should be disposed of immediately after use.
 The user should place sharps directly into an approved container. Never into
  a plastic bag. Never leave sharps to be disposed of by someone else.
 Dispose of syringe and needle as one unit directly into a sharps container
  wherever possible.
 Containers should be conveniently placed for staff to use. Where appropriate,
  take the container to the point of use.
 Ensure that the bin is correctly assembled and that the lid is securely fastened
  before commencing use.
 Sharps containers should not be placed on the floor, on an unstable surface
  or above shoulder height. They should be inaccessible to children and
  unauthorised persons.
 Containers should be sealed and disposed of when three-quarters full (do not
  attempt to press down on container to make more room).
 Never attempt to retrieve any item from a sharps container.
 Containers must not be placed into yellow bags prior to disposal.

 If a sharps container is damaged, place into larger container, lock and label

  prior to disposal.

2.7.3    Sharps containers

There are several types of sharps bins currently on the market but all must
conform to British Standard 7320:1990. UN3291 Wall and trolley brackets can be
used to ensure that bins are conveniently located, especially in areas where
space is limited.
When the bin is three-quarters full, close securely and change. The bin should be
labelled with practice/area name, address and date before disposal. Sealed bins
should not be placed in a yellow bag prior to disposal. Ensure that sealed bins
awaiting collection are housed in a locked area, which is inaccessible to
unauthorised persons.


2.7.4    Sharps Injuries/Splashing Injuries
See also Inoculation Injury policy

This involves:
 Inoculation of blood by a needle or other 'sharp'.
 Contamination of broken skin with blood.
 Blood splashes to mucous membrane, e.g. eyes or mouth.


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    Swallowing a person's blood, e.g. after mouth-to-mouth resuscitation.
    Contamination where clothes have been soaked by blood.

1. Encourage bleeding from the wound.

2. Wash the wound in soap and warm running water.

3. Cover the wound.

4. Skin, eyes or mouth: wash in plenty of water.

5. Ensure the sharp is disposed of safely.

6. During working hours contact the Occupational Health Dept ASAP at Lennard
   Road, 020 8274 6321, who will advise on appropriate action.

7. Out of hours – see Inoculation Injury Policy.

8. Report the incident to immediate supervisor.

9. Attempt to identify source of the needle/sharp (it may be necessary to take a
   sample from the patient for a serum to save for future (DO NOT TAKE
   BLOOD WITHOUT PRIOR DISCUSSION WITH OCCUPATIONAL HEALTH
   OR CONSENT )

10. Complete an INCIDENT report form, and follow instructions.

RE-SHEATHING SHOULD ONLY TAKE PLACE FOR CERTAIN IDENTIFIED
TECHNIQUES. MANY 'SHARPS' INJURIES CAN BE PREVENTED BY NOT
RE-SHEATHING NEEDLES AND BY BEING RESPONSIBLE FOR SAFE
DISPOSAL OF SHARP ITEMS


2.7.5     Splashes to Broken Skin or Mucous Membranes

1. Wash off splashes on skin with soap and running water.

2. Encourage bleeding if the skin has been broken.

3. Wash out splashes in the eye preferably using eyewash from a fresh eye
   wash bottle or alternatively with tap water.

4. Wash splashes in the nose or mouth with copious amounts of tap water.


2.8     Safe Injection Technique

Always wash hands thoroughly prior to giving an injection.




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If visibly dirty, skin should be cleaned with an individually packed swab soaked in
70% isopropyl alcohol and left to dry. If skin is not visibly dirty, this step is not
necessary.

Only staff who are adequately trained and experienced and feel competent to
undertake the task should carry out venepuncture and injections.

After use, hypodermic needles should not be re-sheathed. They should be placed
directly into a sharps container conforming to the British Standard 3720.
Containers should be stored out of reach of patients/residents, visitors and
CHILDREN. The containers should be locked, closed when ¾ full, for disposal
by incineration. The lock must NOT be covered

2.9    Spillage Management

All spillages of blood stained, or potentially blood stained, fluids should be dealt
with immediately.

   Use a spillage kit follow direction contained in the kit
   Keep people away from the area.
   Wear gloves and a disposable apron.
   If there is broken glass use domestic quality gloves to pick up the glass.
    (Gloves are kept in the cleaners’ cupboard.)
   Soak up excess of spill with disposable towels.
   Cover spill with disposable towels.
   Depending on type of spill apply sufficient sodium dischloroisocyanurate
    granules or 10,000 ppm sodium hypochlorite solution (Haztabs, Presept,
    Sanichlor), for at least 5 minutes Follow manufactures guidelines for correct
    dilution.
   Wipe up spill with sodium hypochlorite soaked towels and discard into clinical
    waste sack.
   Wipe surface with general-purpose detergent and hot water.
   Dispose of protective clothing into clinical waste sack.
   Wash hands.

For spills on carpets and upholstery:
 Wear gloves and disposable apron.
 Clear away excess with disposable paper towels, and dispose of as clinical
   waste.
 Clean area with cold water.
 Clean area thoroughly with detergent and hot water.
 Allow to dry thoroughly. It is then no longer an infection risk to others.
 When dry, go over with a mechanical steam cleaner.


2.10 Specimen Handling




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Clinical specimens include any substance, solid or liquid, removed from the
patients for the purpose of analysis. Specimens must be placed in an approved
container immediately after collection and the lid securely fastened. The patient's
details and all relevant details must be entered on the container and the request
form, the container must be placed in a plastic transport bag and the
accompanying request form put into an integral or separate pouch to avoid
contamination.

SPECIMENS MUST NOT BE SENT IN THE INTERNAL POST

The following are the key recommendations to reduce the risk of cross infection
when handling specimens:

    Specimens should be placed in the bag with attached form and then into the
     designated carrying box. Staples, pins or paper clips should not be used.
    Leaking and broken specimens should be disposed of as clinical waste and
     any spillage cleaned up promptly
    Only staff trained to do so should take and handle specimens.
    Aprons and gloves should be worn when taking specimens.
    Specimens should not be placed in areas where food is eaten or stored (e.g.
     kitchen fridge).
    Specimens should not be stored in a drugs fridge.
    Hands should be thoroughly washed after handling specimens.
    Samples tested on site should be disposed of in an appropriate sluice facility
     or toilet (not a sink).
    Any specimen which needs to be sent through the royal mail or by courier
     must be in appropriate packaging which is        in accordance with the safe
     Transport of Dangerous Goods Act 1999

2.11 Vaccines
See Medicines Management Policy

Vaccines are biological products that need to be stored under controlled
conditions in order to maintain their potency and efficacy. A nominated, trained
person should be responsible for ensuring the correct storage and handling of
vaccines. S/he should ensure that stock is rotated and that expired vaccines are
safely discarded.
On arrival at the premises, the vaccines should be checked for damage. Staff
should ensure that the 'cold chain' has not been broken (i.e. vaccine temperature
has been controlled in accordance with manufacturer's instructions). Vaccines
should then be promptly moved to the vaccine fridge. Vaccines should be stored
in a lockable vaccine fridge between +2 and +8 degrees’ Celsius and not below
freezing. The fridge temperature should be monitored and recorded daily using a
minimum /maximum thermometer.

It is important that the fridge is cleaned and defrosted regularly. Stock should not
be stored in fridge doors or in separate drawers at the bottom of the fridge.
Follow the protocol which outlines the action to be taken in the event of the
temperature falling outside the accepted range.


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2.12 Disposal of Waste/Clinical Waste Management

The generator (the provider of health care) of waste has a duty of care to ensure
waste is correctly segregated, sealed and stored before collection for incineration
or land fill. Different classes of waste must be segregated and discarded into
colour-coded containers. The collection of waste should be arranged through a
licensed disposal contractor.


2.12.1 Clinical Waste

When generated on health care premises or as a result of health care, the
following must be disposed of in yellow bags with a biohazard sign, for
incineration:
 Soiled surgical dressings, swabs and all other contaminated waste from
    treatment areas.
 Material other than linen from cases of infectious disease.
 All human tissues (whether infected or not) and tissues from laboratories, and
    all related swabs and dressings.
 Tampons and used sanitary towels; where possible these should be disposed
    of separately in dedicated sanibins.

NB Yellow bags must not be placed in second yellow bag. All bags must be
securely tied and labelled with the white and red tape indicating the place of
origin.

The above regulations require clinical waste that is generated as a result of
health care in an individual's home to be disposed of by incineration. This is then
considered to be the responsibility of the provider of the health care. This
requires clinical waste to be collected from each home by a collection service.
(Contact London Borough of Croydon on 020 8255 2700.)

Waste should be segregated at the point of origin.
Personal protective clothing must always be worn when handling waste.


Handling of Clinical Waste

   Clinical waste should be correctly bagged in yellow bags of 225 gauge to
    prevent spillage.
   Clinical waste bags should be used in a holder or container with a foot-
    operated lid and, so far as is reasonably practicable, out of the reach of
    children.
   Clinical waste bags should only be filled to 2/3 full.
   Clinical waste bags are securely sealed with coded tape at the point of use.
   Bags are not re-used.



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    Clinical waste is not decanted into other bags but remains in the original bag,
     regardless of volume (less than 2/3 full).
    The exterior of the clinical waste bag is uncontaminated and seals are secure.
    Bags MUST be secured with the red and white tape indicating originating
     area/ dept.



2.12.2 Sharps

Discarded syringes, needles, cartridges, small items or broken glass and any
other sharp instruments must be put in the approved sharps container.

In health care premises (e.g. clinics and general and dental practices) all sharps
should be disposed of into a sharps container meeting BS7320
standards/UN3291

2.12.3 Non-Clinical Waste

Other general waste (food waste, non-contaminated paper and household
materials) should be disposed of in black bags.

Brown bags should be used for the disposal of 'domestic' glass or sharp plastic.


2.12.4 Storage of Clinical Waste

Clinical waste should be removed daily to the Clinical Waste Store and then from
point of generation as frequently as circumstances demand, and at least weekly.
Whilst awaiting collection of bulk amounts, waste should be:
 Stored in correctly coded bags, with bags of each colour code kept separate;
 Situated in a separate area of adequate size related to the frequency of
    collection;
 Sited on a well-drained, impervious hard standing floor, which is provided with
    wash down facilities;
 Kept secure from unauthorised persons, entry by animals and free from
    infestation;
 Accessible to collection vehicles.


2.12.5 Transport of Clinical Waste

The issue of transport of clinical waste off-site for eventual disposal is dealt with
specifically in the environmental legislation. Close liaison between producers and
registered contractors is essential.

An identified employee of the premises from which the waste collection needs to
sign a consignment note to confirm the clinical waste has been collected, which is
retained in the Base for two years.


18
A safe system of work includes:
 Written evidence of what is contained within the waste;
 All handlers have received training in the handling of waste;
 All vehicles are licensed to carry waste;
 Handlers are provided with protective clothing;
 An emergency telephone number of the transport company is provided in the
   event of an accident;
 It should be checked that the contractor is registered to transport waste


2.13 Routine Equipment Decontamination
See Medical Devices Policy
All equipment must be appropriately decontaminated between each patient
use.
Decontamination is a combination of processes Cleaning, Disinfection and
Sterilisation
Use Single use Items or CSSD wherever possible.
Never reuse single use Items


2.13.1 Cleaning

Definition : “is a process which physically removes contamination but does not
necessarily destroy micro-organisms. The reduction of microbial contamination
cannot be defined and will depend upon many factors including the efficiency of
the cleaning process and the initial bio-burden.‖ (MDA 1996)

Effective cleaning is an essential pre-requisite of an effective disinfection or
sterilisation process. Items which are dusty soiled or contaminated with organic
matter will not be effectively decontaminated.


2.13.2 Mechanical cleaning

Ultra sonic cleaning baths/washer disinfectors offer an effective method for
cleaning equipment. The following are some key guidelines:
 Always use in accordance with manufacturers instructions
 Use detergent as recommended by manufacturer
 Service as recommended by the manufacturer
 Always ensure only trained staff use the equipment
 Always inspect instruments for residual debris after cleaning and repeat if

    necessary


2.13.3 Manual Cleaning

   Equipment should be washed in a dedicated deep sink (to immerse
    equipment and avoid cross contamination) and a dedicated area.


                                                                                19
 Equipment should be thoroughly washed in detergent and warm water.
  Disinfectant solutions are not required.
 Cleaning equipment (e.g. brushes) should be kept clean and dry between
  use. Brushes should not be stored in disinfectant solutions.
 Brushes should be cleaned decontaminated and stored dry between use.
 Cloths for cleaning equipment should be non-shedding and disposable.
 Staff should wear protective clothing to minimise the risk of contamination.

 Instruments should be stored dry prior to cleaning.



2.13.4 Disinfection

A process used to reduce the number of viable micro organisms but may not
inactivate some microbial agents, such as certain viruses and bacterial spores.
Disinfection processes should be limited to equipment, which cannot be
reprocessed using other methods. Chemical disinfectants should be assessed
under COSHH 1995 and the appropriate controls instituted.

Methods of disinfection:
1. Chemical disinfectants (e.g. peracetic acid, alcohol, chlorine releasing
   agents).
2. Mechanical disinfection – dishwasher or washer disinfector. Follow
   manufacturers guidelines.

2.13.5 Sterilisation

Definition: A process used to render an object free from all living organisms.

Methods of sterilisation:
 Moist heat (saturated steam) e.g. autoclaves
 Dry heat (hot air ovens) DO NOT USE.

 Chemical (e.g. glutaraldehyde, formaldehyde, ethylene oxide) Only to be used

  under controlled conditions such as a Sterile Supplies Department. Not to be
  used in Primary Care.

Water boilers do not sterilise and are not to be used in Primary Care.

2.13.6 Risk Assessment for Decontamination

The method of decontamination used is dependent upon the assessed risk of that
which requires decontamination.

Adequate staff protection measures should also be assessed, documented and
implemented.

Risk              Contact                            Method of decontamination
Minimal           Remote contact - environment       Cleaning
Low               Contact with intact skin, i.e.     Cleaning
                  stethoscope


20
Intermediate       Contact with intact mucous           Single use, or sterilisation
                   membranes, i.e. thermometer,
                   specula
High               Contact with usually sterile        Sterilisation
                   body areas, broken skin,
                   broken mucous membranes,
                   e.g. surgical instruments


2.13.7 Sterilisation

Sterilisation can only be achieved providing the Instrument or equipment has
been adequately cleaned prior to disinfection or sterilisation.           The term
"sterilisation" denotes complete destruction or removal of all forms in microbial
life. It is a mandatory process for all items coming into contact with usually sterile
body areas, broken skin, broken mucous membranes.

Sterile Supplies

Single-use instruments and CSSD for those instruments which must be reused
are to be used wherever Possible.

The use of single-use instruments in such instances ensures the safety of both
the patient and the health care worker.

UNDER NO CIRCUMSTANCES SHOULD SINGLE-USE INSTRUMENTS BE
RE-USED.

Central Services Supply Department

All re-usable devices will be decontaminated in a sterile services department with
requisite facilities and expertise.

Once facilities are available, it will become best practice and policy to obtain pre-
packed sterile instruments and packs from the local Central Sterile Services
Department (CSSD) as they are able to offer specialist advice, have built-in
quality measures and a delivery and collection service

2.13.7.1 Bench-top steam steriliser (autoclave)

Until CSSD becomes available, sterilisation of re-usable instruments is usually
achieved with the use of bench-top steam steriliser. This can be complex and
maintenance can be costly and time consuming. Nevertheless, failure to adhere
to current guidance exposes patients and staff to unnecessary risk and has legal
implications in the event of a device-acquired infection.

The guidance on this procedure is extensive. There are now fourteen acts and
regulations pertaining to this procedure, with European and British standards
coming with further regulations.



                                                                                       21
2.13.7.2 Purchase of sterilisers

DO NOT PURCHASE A NEW BENCH TOP STERLISER WITHOUT
CONSULTING THE CNS INFECTION CONTROL.

It is important to ensure that the steriliser is appropriate for the intended use. An
independent advisor will be able to provide information on a range of sterilisers.
Alternatively, the supplier should be informed what the intended use is, and the
supplier's written assurance obtained that the steriliser is suitable for the purpose.
The purchaser should be aware that the steriliser would need to be installed and
commissioned by an engineer.


2.13.7.3 Maintenance of steriliser

Adequate maintenance is vital in order to ensure that the steriliser is working
effectively. It is strongly recommended that owners are aware of current
guidance. The following is a list of key requirements for effective maintenance. It
is not intended as a comprehensive review

    A schedule should be arranged for periodic testing by a qualified test person.
     Checks should be performed on a quarterly and yearly basis. This contract
     should be overseen by a nominated person at the practice or premises
    A log book should be kept of all the daily and weekly tests/checks/ and all
     repairs should be recorded


2.13.7.4 Use of steriliser

The following is a list of key requirements for effective maintenance. It is not
intended as a comprehensive review.

    Daily checks (automatic control tests) are required. These checks can be
     performed by the USER a trained member of staff using an attached printer.
    Reservoir and chamber: sterile water for irrigation should be used. Chamber
     should be empty, cleaned and dried daily. Water should not be 'topped up'.

It is vital that users and owners are familiar with and carry out requirements
for use and maintenance of the sterilisers according to current guidance.

Instruments must not be wrapped or placed in pouches unless it is a vacuumed
steriliser which has a pre-sterilisation air removal stage and is intended for
wrapped loads.

If instruments are wrapped prior to sterilisation in the bench-top steam autoclave,
there is no guarantee that the instruments inside the wrapping will be sterilised,
even if the wrapping itself is. It is equally important to ensure that all surfaces of
the instruments can be reached by the steam, i.e. they do not overlap or touch
when loaded into the autoclave at the end of the cycle, and the load must be dry.



22
2.13.7.5 Pre-cleaning

The physical cleaning of instruments is a pre-requisite to sterilisation, as this will
ensure all surfaces are free of debris and able to be completely sterilised. Hot
soapy (washing up liquid) water is recognised as the most thorough and cost-
effective means for physical cleaning.

2.13.7.6 Protective clothing

The use of protective clothing is recommended when handling or dealing with
blood and/or body fluids. As these instruments will have been contaminated with
blood and body fluids, and whilst the action of cleaning such instruments may
give rise to splashing with these fluids, household gloves, disposable aprons and
eye protection should be worn.

2.13.7.7 Scrubbing brushes

Whilst the use of scrubbing brushes is generally not advocated, it may prove
impossible to clean instruments effectively without them. Therefore, if they are
used they must be either single-use or they are themselves autoclaved after
every use.


2.13.8 Decontamination of Health Care Equipment Prior to
       Inspection, Service or Repair

See Medical Devices Policy

All equipment must be adequate and safely decontaminated prior to inspection,
service or repair

Equipment should never be presented or sent for service in a soiled condition.

A decontamination form declaring the decontamination status must be attached
to every piece of equipment being sent for service.

All decontamination procedures should be performed by suitably qualified, trained
staff. Follow manufacturer’s guidelines on decontamination process.

Always use universal precautions/standard Infection control precautions.

Washer/Disinfector is now at Accessibility Ability Centre. Arrangements can be
made through the Centre (8664 8860).

Equipment that HAS been contaminated and is impossible to decontaminate.
This is likely to be complex, high technology equipment that is heat-sensitive, and
equipment, which cannot be decontaminated without being dismantled by an
engineer. In this event, a "Biohazard" label should be attached to the item. The




                                                                                   23
clearance certificate should be completed accordingly and staff advised on
protective measures required.



2.14 Environmental Hygiene
See Cleaning Policy

Environmental hygiene is an important component of good infection control.
Overall, the environment should be visibly clean, free from dust and soilage dry,
well lit and well ventilated. In health centres waiting area should allow
segregation of potentially infectious patients.

All areas should be cleaned and damp dusted regularly. Detergent and clean hot
water is adequate for most routine cleaning requirements (added to this, many
disinfectants are not effective in the presence of dirt and organic matter).
Equipment such as mops buckets and cloths should be specifically designated
for the area of use and stored clean and dry. Mops should be washed regularly
and stored inverted after use.


2.14.1 Clinical Areas

Clinical areas should not be used for non-clinical work or storage if there is any
risk of contamination or if it affects the cleanliness of the area.

The cleaning specification for clinical areas MUST be adhered to all times

Food and drink MUST NOT be prepared, stored or eaten in Clinical Areas.

Food and drink must NOT be put in specimen or vaccine fridges.

No other consumables should be brought into the clinical area or stored in the
specimen fridge.

    Clean, dirty and an admin work areas should be identified to prevent cross
     contamination.
    The room should be uncluttered to allow easy access for cleaning.
    Work surfaces should be made of materials, which can be easily cleaned.
    Flooring should be a sheet finish and coved to allow effective cleaning.
     Carpet is not appropriate.
    Examination couch covering should be impermeable and intact. Paper rolls
     should be used to cover the couch and changed between patients.
    Used instruments should be stored dry in a lidded container prior to cleaning.
    Sterile stock should be stored off the floor




24
2.15 A Brief Guide to Cleaning and Disinfecting Agents

Agent                   Preparation                           Use
General purpose         As supplies                           Routine and
detergent                                                     environmental
                                                              cleaning
Hypochlorite            Cleaning powders containing           Disinfection
detergent               hypochlorite are available and
                        their use (following manufacturer's
                        instructions) may well be easier
                        than the alternative which is to
                        make up a solution as follows:

                        NaDCC tablets* or liquid bleach
                        made up to 1,000 ppm in a
                        solution of general-purpose
                        detergent and water. It is
                        important to follow manufacturer's
                        instructions
Hypochlorite solution   NaDCC tablets* or granules, or        Blood and body fluid
                        liquid bleach, made up to 10,000      spillages
                        ppm in water. NB: Fumes from
                        urine
Alcohol                 70% Spray                             Disinfection of hard
                               Wipes                          surfaces and hands
                               Bottle                         which have already
                                                              been cleaned


*NaDCC = Sodium dichloroisocyanurate (e.g. Presept, Sanichlor)

Note on Hypochlorite - this should only be used on equipment which has no
visible dirt.

The manufacturer's instructions should be carefully checked, but generally a
dilution of 1 part commercial household bleach to 10 parts water is required.

Liquid bleach, which is not in use on Trust Premises, should be stored in a cool,
dark, secure place and used within six months of purchase. The Control of
Substances Hazardous to Health (COSHH) regulations apply to liquid
bleach and NaDCC tablets. Fresh solutions of hypochlorite should be made up
daily, as required, as these solutions rapidly become inactive.




                                                                                25
2.16 Notification of Infectious Disease

A doctor who suspects that a patient is suffering from one of the following
infectious diseases must notify the Local Authority's 'proper officer' (usually the
CCDC).

      Anthrax*                             Paratyphoid fever*
      Cholera*                             Plague*
      Diphtheria*                          Poliomyelitis (acute)*
      Dysentery                            Rabies*
      (Amoebic or bacillary)
      Encephalitis (acute)                 Relapsing fever
      Food poisoning**                     Rubella
      Leprosy*                             Scarlet fever
      Leptospirosis                        Smallpox*
      Malaria                              Tetanus
      Measles                              Tuberculosis - all forms
      Meningitis*                          Typhoid fever*
      Meningococcal Septicaemia*           Typhus*
      (Without meningitis)                 Viral haemorrhagic fever*
      Mumps                                Viral hepatitis
      Ophthalmia neonatorum                Whooping cough
      Yellow fever

*     For diseases marked with an asterisk, please telephone your Consultant in
Communicable Disease at the South West London Health Protection Unit
Control on 020 8682 6132, as well as sending a notification form.

**     Cases of food poisoning or dysentery in a food handler should be notified
by telephone/fax to your Proper Officer. For all cases of food poisoning, obtain a
specimen (pot) and ask patient to note recent food history.

A doctor who suspects that a patient is suffering from a notifiable disease has a
responsibility under the Public Health (Control of Disease) Act 1984 and Public
Health (Infectious Diseases) Regulations 1988 to notify the Proper Officer
(CCDC) for the Local Authority. It is not necessary to wait for confirmation of
diagnosis in order to notify. (Contact details on Notification Form)

The book of forms for notification of infectious diseases is available from your
local Environmental Health Officers. Please fill out the form and return it to The
Consultant in Communicable Disease Control at your local Environmental Health
Department.

You will receive a fee for each notification.




26
2.17 References

The contents of this policy are consistent with current guidelines, best practice as
agreed by the relevant bodies including The Infection Control Nurses Association,
The Hospital Infection Society and Medical Microbiologist society, and evidence-
based research.

Hand washing guidelines DOH May 2001:

 Camden and Islington Community Health services NHS Trust Infection Control
policy 1999
 UCL Infection Control manual May 1999

Handwashing Techniques; Lawrence; 1988

Applied Microbiology; Caddow P ed; London Scutari Press 1990

Winning Ways Working together to reduce Healthcare Associated Infection in
England Report from CMO December 2003,

Infection Control in Clinical Practice; Jennie Wilson1992

Examination gloves as a barrier to hand contamination in clinical practice; Olsen
Lynch Coyle; 1993

Heptonstal et al; 1993

Building Barriers against Infection; Gill & Slater; 1991

Health Care Workers and HIV; Heptonstal et al; 1993

DOH Guidelines for the Safe and Secure handling of Medicines; 1988

Use of granules for spills of body fluids; Coates & Wilson; 1989

A code of Practice for the safe use and disposal of sharps; BMA; 1990

Environmental Protection Act 1990

Safe Disposal of Clinical Waste Regulations; 1992

The Safe Disposal of Clinical Waste; H & S Commission 1992

Decontamination of Equipment prior to Inspection, service or repair; NHS
Management Executive; 1993

Central of Hospital Infection - a Practical Handbook; Ayliffe G, Laubury E et al




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