Infection control - key risks

So, let's consider some of the key risks and how these may impact on your practice...

Staff immunisation

infection control icons 1 In 45% of practices visited, GPs had not considered vaccinations required for members of staff. The Safety, Health and Welfare at Work (Biological Agents) Regulations 2013² makes provision for this if there is a risk to the health or safety of employees caused by working with a biological agent. A biological agent includes a virus, bacterium or fungus that has an ability to adversely affect human health.

The Infection Prevention and Control Guidelines for Primary Care state: “In addition to GPs and Practice Nurses, administrative and cleaning staff may be exposed to communicable diseases and/or blood/bodily fluid exposure, and therefore should be vaccinated as appropriate. Decisions about vaccinations recommended should be based on the duties of the individual rather than on job title alone.”³

Recommendation

All clinical and nonclinical staff should be offered vaccination if a risk assessment reveals that their work may expose them to blood borne virus infection and other infectious diseases, eg, Hepatitis B, influenza.² Please also refer to the RCPI’s Immunisation Guidelines for Ireland.⁴

Specimen handling

How often do reception staff handle specimens within your practice? Do patients bring samples in inappropriate containers and pass these directly to the receptionist? The outside of the container could be contaminated. Forty-four percent of practices visited in 2013 had risks associated with specimen handling.

Recommendation

Reception staff should not touch patient specimens and samples in inappropriate containers should not be accepted. GPs should issue the patient with a labelled specimen container when requesting a specimen, removing the need to decant samples. A box could be provided at the reception desk for patients to leave their samples, which can be passed straight to the nursing staff.

Cleaning of premises

Of the practices visited in 2013, 40% had risks associated with cleaning of the premises. This did not relate to the effectiveness or efficiency of those undertaking the housekeeping roles, but rather to the schedule of cleaning for each practice.

Recommendation

Have a regular, planned and monitored cleaning schedule which provides details about how the environment and equipment (eg, chairs, examination couches) are to be cleaned – and how frequently.

Wash and change floor mops regularly. Mops, buckets and cleaning cloths should be colour coded and different mops/cloths should be used to clean clinical and public areas. Mops should be hung to dry and should not be left wet in buckets.

Training

Forty percent of practices did not provide staff training on infection control.

Appropriate infection control is integral to the health and safety of patients, practitioners and staff. With the right systems, processes and training, the risk of infection can be detected and managed.

Recommendation

Provide staff with training in infection prevention and control at induction and through regular updates. Topics should include: hand washing, management of sharps and clinical waste, and management of spillages of blood and body fluids, among others.

Toys

In MPS experience, many waiting room toys are not cleaned routinely. Soft toys are hard to disinfect and rapidly become re-contaminated after cleaning, whereas hard toys such as a bead frame or activity table can be easily disinfected.

Recommendation

Remove all soft toys from the practice. Regularly check hard toys to ensure they are safe and clean regularly as part of the cleaning schedule.

Hand washing

Twenty six percent of practices visited did not provide staff with hand washing training. Effective hand washing prevents the transmission of micro-organisms to yourself and others – it’s the single most important procedure for infection control.

Recommendation

Teach all healthcare staff how to correctly clean their hands with alcohol handrub and with soap and water.

Ideally you should make available:

Liquid soap dispensers
Appropriately placed alcohol handrub product
Paper towels – cloth towels are a recognised source of cross-infection
Elbow-operated mixer taps
A designated hand washbasin, separate from the one used for equipment.
Alcohol handrub 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
If there is direct hand contact with bodily fluids, ie, if gloves haven’t been worn
If the patient is experiencing vomiting and/or diarrhoea.

In these instances, hand wash with antiseptic soap or plain soap followed by use of an alcohol rub is recommended. Staff should have access to suitable personal protective equipment such as gloves, aprons and eye protection.

Dealing with spillages

Spillage kits were not available in 25.5% of practices visited. Blood and body fluid spills should be dealt with quickly and effectively. All staff should know who is responsible for spillage management in their work area. In clinical areas this would normally be the nursing staff.

Domestic cleaning may also be required after the body fluid spillage has been dealt with.

Recommendation

Consider providing a ‘grab bucket’ containing all the relevant equipment to deal with a spillage of body fluids. The kit should be kept in a designated place (you may need more than one kit). The kit should comprise:

‘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 compounds should be kept in a lockable cupboard.
absorbent powder, eg, vernagel to soak up the liquid content of the spillage.

The kit should be immediately replenished after use. Alternatively, you may wish to purchase a commercially produced spillage kit.

Decontamination of reusable medical devices

Many practices do not have robust procedures for decontaminating reusable medical devices.

This includes cervical specula, auroscope pieces, scalpel blade holder, scissors and forceps. Failure to comply with current primary care guidelines would make a claim difficult to defend should a patient suffer an adverse event.

Recommendation

Consider the use of sterile single use devices, which will remove the need for decontamination. If your practice uses reusable medical devices, the decontamination process must be robust and comply with the Code of Practice for Decontamination of RIMD (2007).5

Infection Prevention and Control Guidelines for Primary Care states: “It is difficult to achieve adequate decontamination in a general practice setting…for this reason the use of single/disposable equipment is preferable.”3

Infection control guidelines

The Infection Prevention and Control Guidelines for Primary Care3 have beenproduced by the National Clinical Programme for HCAI and AMR (antimicrobial resistance) prevention, in collaboration with the ICGP.

The guidelines provide advice for infection prevention and control in general practice and include audit tools to assess current practices and plan for future practice development and training.

Top tips for effective infection control in general practice:

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

How can MPS help your practice

MPS has developed an interactive workshop to 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.

Practices may wish to complement this workshop by booking an Infection Control Risk Assessment for the practice. An Infection Control Risk Assessment involves a two to three hour practice visit by one of our expert facilitators. The risk assessment is a supportive process that is tailored to the needs of the practice, giving a very personal quality improvement experience. www.medicalprotection.org/ireland/infectioncontrol

Summary

Today, patients have high expectations for their healthcare needs – particularly when it comes to healthcare providers meeting hygiene standards. A key part of achieving this is ensuring effective infection control and prevention systems within your practice.

References

1. MPS, Clinical Risk Self Assessments www.medicalprotection.org/ireland/education-and-events/clinical-risk-selfassessments-for-GPs
2. Safety, Health and Welfare at Work (Biological Agents) Regulations 2013 www.hsa.ie
3. HPSC and HSE, Infection Prevention and Control for Primary Care in Ireland (April 2014) www.hpsc.ie
4. RCPI, Immunisation Guidelines for Ireland (revised edition online 2011) www.immunisation.ie
5. Health Service Executive, Code of Practice for Decontamination of RIMD (2007) www.hse.ie

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