ARTICLES

Suzanne Creed, clinical risk and education manager at Medical Protection, outlines some practical tips on infection prevention and control for your practice

Winter season is upon us, seasonal flu is rife, vomiting bugs are prevalent and it seems like every second patient is complaining of a cough and cold – does this sound familiar? Perhaps it’s a good time to think about infection prevention and control in your practice? 

This is an essential element of care and one that has often been undervalued in recent years. All staff, clinical and non-clinical, have a responsibility to help reduce the prevalence of healthcare-associated infections. Infection prevention and control is not just about keeping your patients safe, but also keeping you and your practice staff safe. So let’s consider some of the key risks and how to mitigate them in your practice. 

Hand hygiene

According to the Health Information and Quality Authority (HIQA), hand hygiene is recognised as the most important preventative measure in transmission of healthcare associated infections.¹ Effective hand hygiene prevents the transmission of micro-organisms to you and others.

Recommendations

All healthcare staff should be taught how to correctly clean their hands with alcohol-based hand sanitiser and soap and water. Alcohol-based hand sanitiser is the recommended product in all patient care situations except:

• After contact with a patient with known or suspected diarrhoea, eg clostridium difficile or norovirus.
• Where hands are visibly soiled.
• When there is direct hand contact with bodily fluids, ie if gloves were not worn.
• If the patient is experiencing vomiting or diarrhoea.

In these instances, hand washing with antiseptic soap or plain soap followed by use of an alcohol-based hand sanitiser is recommended.

Ideally you should make available:

• liquid soap dispensers
• appropriately-placed sanitiser
• paper towels
• elbow-operated mixer taps
• a designated hand washbasin, separate from the one used for equipment, etc.

Protecting your staff

As employers, GPs should introduce reasonable measures to minimise the risk of employees acquiring or spreading infection. GPs, practice nurses, administrative and cleaning staff may all be exposed to communicable diseases or blood/bodily fluid exposure and therefore should be vaccinated as appropriate. Staff vaccination reduces the risk of contracting various diseases, reduces onward transmission of disease to patients and avoids sick days due to ill health. The Infection Prevention and Control Guidelines for Primary Care states: “Decisions about vaccinations recommended should be based on the duties of the individual rather than on job title alone.”²

Recommendations

All staff members should be offered vaccination against influenza on an annual basis each autumn. Healthcare workers who are at occupational risk of exposure to blood or bodily fluids or who perform exposure-prone duties should be immunised against hepatitis B. This includes your practice cleaner. In line with the Infection Prevention and Control Guidelines for Primary Care, staff should also be screened and offered vaccinations against:

• BCG (Bacillus Calmette Guerin)
• Varicella
• MMR (measles, mumps, rubella).²

Specimen handling

How often do reception staff at your practice handle specimens? Do your patients drop in samples in inappropriate containers and pass them directly to your reception staff? The outside of these containers could be contaminated, resulting in a risk to your staff.

Recommendations

Reception staff should not touch patient specimens and samples, and inappropriate containers should not be accepted. Clinical staff should issue the patient with a labelled specimen container and appropriate pathology bag when requesting a sample, thus ensuring samples are transported safely and removing the need to decant samples. A drop-box could be provided at the reception desk for patients to leave their samples in, which could then be passed directly to the clinical staff.

Dealing with spillages

Who deals with spillages in your surgery? Have they been appropriately trained? As with any GP practice, unexpected spills of blood, urine or vomit are not uncommon. Blood and body fluid spills should be dealt with swiftly and effectively to minimise risks to staff and patients. All staff should know who is responsible for spillage management in their work area. They should be appropriately trained and have the necessary equipment to manage the spill.

Recommendations

Practice staff should be provided with appropriate training. The Infection Prevention and Control Guidelines for Primary Care provides guidance on the management of different types of spillages, ie blood, urine and vomit.²

Consider providing a 'grab bucket' containing all the relevant equipment. This should be readily available to deal with any spillage of body fluids. The kit should be kept in a designated place and you may need more than one.

The kit should comprise of a:

• 'nappy' type bucket with a lid
• non-sterile vinyl gloves and latex/nitrile gloves for contact with blood
• disposable plastic apron
• disposable face protection
• disposable paper towels
• disposable cloths
• clinical waste bag
• small container of general purpose detergent
• sodium dichloroisocyanurate compound NaDCC (eg Presept^®, Sanichlor^®, Haz-Tabs^®) or hypochlorite solution (eg household bleach or Milton^®). These chemicals should be kept in a lockable cupboard
• absorbent powder, eg Vernagel^® to soak up the liquid content of the spillage
• floor warning sign.

The kit should be immediately replenished after use.

Cleaning and decontamination of reusable instruments

Many practices find it challenging to comply with current guidelines for decontamination of reusable instruments – in particular, having separate clean and dirty areas for decontaminating equipment that is not a clinical room or used for any other purpose, having separate sinks for washing and rinsing instruments and a thermal washer for cleaning instruments, to name just a few.

Failure to comply with current guidelines as outlined by HIQA,¹Infection Prevention and Control Guidelines for Primary Care,^2, HPRA³ and the HSE Code of Practice for Decontamination of RIMD⁴ would make a claim difficult to defend should a patient suffer an adverse event.

Recommendations

Consider using single-use disposable equipment. This will remove the need for decontamination procedures. If your practice uses reusable medical devices you need to ensure that your decontamination processes are safe and robust, and fully comply with current standards and guidelines.

Cleaning of the practice premises

Having clean premises will not just have a positive impact on a patient’s experience but will also reduce micro-organisms in the environment. It is important to have routine environmental cleaning to minimise the number of micro-organisms and to ensure cross contamination is greatly reduced.

Recommendations

Develop a detailed cleaning schedule for your practice. This should provide details about how the environment and equipment, eg chairs and examination couches, are to be cleaned and should detail the frequency and method of cleaning. Floor mops should be regularly washed and changed periodically. Mops and buckets should be colour coded and different mops should be used to clean clinical and public areas. Mops should be hung to dry and not left wet in buckets. Cleanliness of the premises should be regularly monitored and any shortcomings addressed with your cleaner or cleaning company.

Training and guidelines for your practice

All staff should receive training in infection prevention and control at induction and have regular updates. Key topics should include: hand hygiene, management of sharps and clinical waste, and management of spillages, amongst others.

It may be helpful to consider appointing a designated lead within the practice who will take charge for infection control issues. You should discuss and develop a robust infection control policy and ensure all staff are conversant in its contents. It is essential to ensure the policy is regularly reviewed and updated.

Medical Protection has developed an interactive Infection Control Risk Assessment and Workshop to give general practice teams a clear understanding of the importance of infection control, providing you with the necessary skills to manage and reduce infection in your practice.

Infection prevention and control is a fundamental part of a high quality general practice service. It will ensure the safety and wellbeing of patients, staff and visitors to your practice. Achieving and maintaining the highest hygiene standards is everyone’s responsibility.

References

1. Health Information and Quality Authority. National Standards for Infection Prevention and Control in Community Services. HIQA website. 2018. [Accessed 2019 Aug 1]
2. Lemass H et al. Infection prevention and control for primary care in Ireland: a guide for general practice. HPSC website. 2014. [Accessed 2019 Aug 1]
3. Irish Medicines Board. Safety Notice: Cleaning and Decontamination of Reusable Medical Devices. HPRA website. 2010. [Accessed 2019 Aug 1]
4. Health Service Executive. Code of Practice for Decontamination of Reusable Medical Devices. HSE website. 2007. [Accessed 2019 Aug 1]