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Risk alert: Infection control

Infection controlKate Taylor, MPS Clinical Risk Manager, highlights the importance of infection control in general practice

It’s a busy Friday morning and as the practice nurse you have a full childhood immunisation clinic. While treating patients you inadvertently sustain a needle stick injury – how do you deal with this situation? Does the practice have policies and procedures in place to manage it?

Infection control in general practice is not just related to preventing sharps injuries; it covers much more. All staff working in general practice play a vital role in infection prevention and control.

Care Quality Commission (CQC)

As infection control is one of the Care Quality Commission’s Essential Standards, general practice teams need to ensure that they have suitable arrangements in place to ensure patients experience care in a clean environment and are protected from acquiring infections.1

The Health and Social Care Act 2008 Code of Practice on the prevention and control of infections and related guidance became effective from April 2013, and sets out the criteria that registered providers of healthcare should follow to ensure compliance with the CQC’s registration requirements for cleanliness and infection control.2

Risk associated with infection control

MPS undertakes Clinical Risk Self Assessments (CRSAs) of general practices – this is a systematic approach to identifying risks and developing practical solutions to ensure quality of practice, and preventing harm to patients.3 MPS has conducted in total more than 1,000 CRSAs in practice. We analysed data obtained from more than 120 CRSAs conducted during 2012 – the results revealed that 85% of practices visited had issues regarding infection control. A further analysis of these risks is detailed in Figure 1. We’ll now explore some of the key areas.

Infection control Figure-1

Cleaning of premises

Of the practices visited in 2012, 41% had risks associated with the cleanliness of the premises; this did not relate to the effectiveness or efficiency of those undertaking the housekeeping roles, but rather the schedule of cleaning for each individual practice.

Practices should ensure that they have a regular planned and monitored cleaning schedule, which provides details on the environment and when equipment, such as chairs, examination couches and toys, should be cleaned and how frequently.

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 should not be left wet in buckets.

Specimen handling

How often do reception staff handle specimens within your practice? Are patients experts in ensuring sample bottles are not contaminated? Almost 44% of practices visited in 2012 had risks associated with specimen handling. 

Practices should ensure that they have a regular planned and monitored cleaning schedule

As part of the practice’s infection control policy, reception staff should not touch patient specimens, and samples in inappropriate containers should not be accepted. GPs should ensure that they issue the patient with a labelled specimen container when requesting a specimen; this should reduce the number of specimens being presented in unsuitable and unlabelled containers. It will also prevent the need for decanting samples. A box could be provided at the reception desk for patients to leave their samples, which can then be passed directly to the nursing staff.

Hand washing

Almost a quarter of those practices visited had not provided staff with training on hand washing. Ensure that all staff receive appropriate training and use the six-step technique before and after direct contact with a patient in accordance with NICE guidance.4 Replace any cloth hand towels with paper towels, as cloth towels are a recognised source of cross infection. Staff should also have access to suitable personal protective equipment, such as gloves, aprons and eye protection. 

Clinical waste/sharps

Of the practices MPS visited, 5.8% had risks associated with clinical waste and the management of sharps. For example not using pedal operated clinical waste bins, clinical waste bins not being provided in the consulting room and inappropriate storage of clinical waste awaiting collection.

Practices must ensure they comply with the Control of Substances Hazardous to Health (COSHH) Regulations 2002, ensuring that all staff are instructed how to dispose of waste correctly and safely.5 All hazardous liquids such as bleach should be stored in a lockable cupboard.

As part of the practice’s infection control policy, reception staff should not touch patient specimens, and samples in inappropriate containers should not be accepted

COSHH also states that staff should ensure that needles are disposed of in the sharps containers at the point of use.

Dealing with spillages

Spillage kits were not available in 26.7% of the practices visited. Ensure that the practice provides spillage kits, either purchased or made up in-house, for dealing with spillages such as body fluids, blood and mercury (if applicable). Contact your local infection control nurse about requirements for the safe cleaning of hazardous substances. It is also good practice for staff to be offered hepatitis B immunisation.

Training

Just under 32% of practices visited had not provided staff training on infection control. MPS experience of CQC inspections leads us to understand that training records provide key evidence to demonstrate compliance.

Toys

In MPS experience many waiting room toys are not cleaned routinely. Soft toys are hard to disinfect and tend to rapidly become re-contaminated after cleaning. Conversely, hard toys can be cleaned and disinfected easily. MPS advises the use of a bead frame or activity table that can be easily cleaned.

All staff in the practice should receive appropriate infection control training

Summary

Today, patients have increased and differing expectations of their healthcare needs and requirements, none more important than the expectation that healthcare providers will meet standards of hygiene. A key component to achieving this is to ensure effective infection control and prevention systems within your practice.

Top tips for ensuring compliance with CQC registration

  1. Ensure the practice has a nominated lead responsible for infection control issues
  2. Make sure the premises are clean, with a designated person responsible for cleaning
  3. Provide accurate information for patients about infection control
  4. Provide accurate information on infections to all persons providing support or nursing/medical care
  5. Patients who have infections should receive appropriate initial advice and treatment
  6. All staff in the practice should receive appropriate infection control training
  7. Provide adequate isolation facilities for patients presenting with an infectious condition
  8. Secure adequate access to diagnostic, microbiology and virology laboratory services
  9. Discuss and maintain infection control policies, such as safe handling and disposal of sharps, aseptic technique, decontamination of instruments etc
  10. Ensure healthcare workers are protected from exposure to infections. 
Useful links

How can MPS help your practice?

MPS has developed an interactive workshop that will give general practice teams a clear understanding of the importance of infection control, providing you with the skills to manage and reduce infection in your practice. Click here for more information.

MPS also offers an Infection Control Risk Assessment Workshop. This involves a two to three hour practice visit by one of our expert facilitators. During the visit the facilitator will:

  • review your current approach to infection control
  • undertake semi-structured interviews with key practice staff
  • identify areas of risk within your practice relating to infection control. 
References
  1. CQC, Essential Standards of Quality and Safety (2010)
  2. Health and Social Care Act, Code of Practice on the Prevention and Control of Infections (2008)
  3. MPS, CRSAs
  4. NICE, Clinical Guideline 139, Prevention and Control of Healthcare Associated Infections in Primary and Community Care (2012)
  5. Control of Substances Hazardous to Health (COSHH).
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