HEALTH & SAFETY INFECTION CONTROL

ADULT SERVICES DEPARTMENTAL PROCEDURE NO: 03/13

Infection Control in Provider Services and Community Settings

DATE: 1 July 2013

EFFECTIVE DATE:

1 July 2013

CATEGORY: Health and Safety, Infection Control

ISSUED BY: David Vallender, Head of Health and Safety

CONTACT: Refer to Infection Control Lead for Adult Services, or David Vallender, 01962 847784 or SSHQCRDV

PROCEDURES CANCELLED OR AMENDED:

Cancel Procedure No. 07/12

REMARKS: This procedure describes how Adult Services reduce the risk of social care related infections.

SIGNED: Gill Duncan

DESIGNATION: Director, Adult Services

YOU SHOULD ENSURE THAT:-

You read, understand and, where appropriate, act on this information

All people in your workplace who need to know see this procedure

This document is available in a place to which all staff members in your workplace have access

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PURPOSE

To set out the Department’s requirements in relation to infection control.

SCOPE

The procedures describe the responsibilities of all employees (including agency staff) and managers to maintain high standards of infection control in operational premises and community settings, including people’s homes. The procedure gives guidance to staff about how they can put the infection control measures in place in the workplace and guidance on specific precautions to take if an outbreak of infection occurs.

REFERENCES TO LEGAL, CENTRAL GOVERNMENT AND OTHER EXTERNAL DOCUMENTS, INCLUDING RESEARCH

Health and Safety at Work etc. Act 1974Management of Health & Safety at Work Regulations 1999The Care Homes Regulations 2001Health & Social Care Act 2008 Health & Safety in Care Homes – HSE Books, HSG220Care Quality Commission Regulations 2009NICE Clinical Guideline 139, Prevention and control of healthcare associated infections pathway 2012Health and Safety (Sharp Instruments in Healthcare) Regulations 2013

HAMPSHIRE COUNTY COUNCIL AND ADULT SERVICES DEPARTMENT REFERENCES

Control of Substances Hazardous to Health (COSHH) 23/06Personal Protective Equipment 22/01Water Systems Management 26/08Cleaning Manual 04/10Laundry Manual 08/07Waste Disposal 28/05HCC Adult Services Contracting Processes

DEFINITIONS

For the purposes of this policy, infection control covers a range of measures intended to reduce the risk of infection in HCC Provider Services establishments. These include cleaning, laundry and waste disposal.

AUTHORITY TO VARY THE PROCEDURE

Director, Adult Services

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CONTENTS

1. MANAGEMENT SUMMARY

2. LEGAL REQUIREMENTS

3. INTRODUCTION

4. PRINCIPLES OF INFECTION

5. DAILY CONTROL MEASURES

6. DISPOSAL OF WASTE

7. SHARPS

8. INFORMATION & TRAINING

9. EMPLOYEE RESPONSIBILITIES

10. INFECTION CONTROL LEADS

11. PERFORMANCE MANAGEMENT STANDARDS

12. INFORMATION SOURCES

13. MANAGING AN OUTBREAK OF INFECTION

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1. MANAGEMENT SUMMARY

1.1 Infection control is a key part of an effective risk management programme that will ensure the service user experience and their time with us is safe and without any additional risks to their health. It will also help maintain the occupational health of our staff.

1.2 Control of infection starts with preventative measures such as thorough cleaning, following safe working practices and the application of standard universal precautions. But if an outbreak occurs then additional measures will be required.

1.3 Infection is a major cause of illness in places like care establishments so we need topractice prevention wherever we provide care and put in place effective control measures to minimise any risk.

1.4 All staff, especially those providing direct care to service users, are expected to participate in the prevention and control of infection by adopting good practice and following infection control practices at all times.

1.5 The philosophy of this policy document is to encourage individual responsibility by every member of staff. It recommends safe practice through a number of specific procedures and also points to other sources of advice and information both from within the Department and external sources.

2. LEGAL REQUIREMENTS

2.1 Health & Safety at Work etc. Act 1974Employers owe a duty of care for the health, safety and welfare of all employee

whilst they are at work and to other people who may be affected by their activities. They must comply with the statutory duties contained within the Act, as amended, as well as those Regulations made under it.

2.2 Management of Health & Safety at Work Regulations 1999Prominent among the requirements of these regulations is the duty to carry out suitable and sufficient risk assessments on all work activities.

2.3 The Care Homes Regulations 2001, Part III (16) Facilities and servicesCovers the provision of adequate quantities of wholesome and nutritious food, suitable kitchen equipment and adequate facilities for the preparation and storage of food. That includes the prevention of infection and cross contamination.

2.4 Health & Social Care Act 2008, (Regulated Activities) Regulations 2010Part 4, Regulation 12 covers cleanliness and infection control in a healthcare setting. See also CQC Outcome 8.

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3. INTRODUCTION

3.1 The aim of infection control measures is to limit the acquisition and spread of harmful micro-organisms within the range of care settings we provide so the challenge for us is a complex one and covers a wide range of activities and actions.

3.2 Many infectious diseases are easily spread through care establishments, where large numbers of people are in close proximity and share eating facilities and living accommodation.

3.3 Hand washing is the single most effective precaution against the spread of infection. This includes hand washing for staff, service users and visitors.

3.4 The following procedure and links to official advice from external agencies are part of our overall infection control safety measures.

4. PRINCIPLES OF INFECTION

4.1 Sources of Infection: Organic matter - excreta, blood, body fluids, exudates from

wounds and lesions Stagnant fluids - standing water systems without regular flushing Equipment - air conditioning systems, humidifiers, ventilators Water systems - sinks, taps, water and waste pipes, drains

4.2 Route of Spread: Direct contact - hands, surgical dressings Airborne indirect - organisms in dust, skin scales Airborne droplets - aerosols, coughs and sneezes Direct inhalation - inhalers and nebulisers Food borne/ingested - contaminated food, out-dated foodstuffs Blood borne - needle-stick injury, spillage of contaminated

body fluids, uncovered/open cuts and abrasions Insect borne - cockroaches, ants, flies, mosquitoes

5. DAILY CONTROL MEASURES

5.1 The achievement of overall cleanliness has a direct link to preventing infection. Goodpractice is essential to maintain safe and healthy conditions for service users, staff,contractors and visitors.

5.2 When giving personal care, the application of standard universal precautions andrecommended clinical standards will ensure that the risk of cross infection is minimised. Use of universal precautions (see below) and appropriate disposal of waste products is equally important but keeping hands clean is paramount.

Staff must wash their hands o before and after giving personal careo after contact with body fluidso after removal of gloves

Staff should wear protective gloves and disposable apron when providing personal care or dealing with waste

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Staff must change disposable aprons and gloves between each service user Staff must cover any skin lesions or cuts with waterproof dressings

(staff involved in preparing food must use blue dressings) Staff should encourage and assist service users to wash their hands after

using the toilet and before meals

5.3 Cleaning the premises thoroughly and efficiently by removing the daily build-up of dirt, dust and spillages will not only improve hygiene but also control odours and give the premises a fresh welcoming appearance and improve the whole ambiance.

5.4 The use of daily cleaning schedules will ensure that all areas receive the correct amount of attention. (See the Cleaning Manual)

5.5 Laundry operations must also follow infection control guidelines in order to maintain quality standards and prevent the spread of infectious diseases.(See the Laundry Manual)

6. DISPOSAL OF WASTE

6.1 Classification of Waste:

Domestic/household waste including food waste from kitchen, non-contaminated paper waste and household materials.

Non-domestic waste including clinical, offensive, sharps and toxic materials such as fuel.

6.2 Household waste:6.2.1 Household or domestic waste is waste which is normally collected by the general

refuse disposal services. Clinical or offensive waste must never be included in household waste.

Household waste should be collected and placed in Black plastic bags. The bags should not be filled to more than three quarters full and then be securely tied to prevent spillage

Food waste must be double bagged Broken household glass, including china, crockery, etc., must be wrapped in

newspaper before being placed in a black plastic bag Full black bags must never be left to accumulate inside the building and

should be removed to the waste storage area as they are generated Storage bins should be sited in a designated area and have lids which can be

closed and secured Collection will be through the normal refuse collection services.

6.3 Non-domestic waste – Clinical, Offensive, etc:6.3.1 Clinical waste is any waste which consists of human tissue, body fluids and body

waste, disposable garments (such as gloves and aprons), used incontinence pads, soiled dressings, etc. likely to be contaminated.

White pedal bins, with orange lids and Orange bags ,should be available for the disposal of clinical waste in places where the waste is generated such as toilets, bathrooms and clinical areas

The bin liner should be securely tied before removal from the bin to avoid spillage

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Staff changing the bin liners must wear disposable protective gloves and aprons at all times and these items must also be treated as clinical waste

Good practice must be used when transporting clinical waste bin liners to the yellow clinical waste sacks

Clinical waste must never be placed in black sacks with household rubbish

Collection of clinical waste will be undertaken by the appointed specialist waste disposal contractor

Note: Disposal of clinical waste is subject to strict legislative controls. A Certificate of Collection/Disposal will be issued by the contractor for each load collected as confirmation that the load has been disposed of according to The Environmental Protection Act and these must be retained by the Registered Manager.

6.3.2 Offensive waste is any waste contaminated with non-infectious body fluids, such as incontinence pads, disposable garments (such as gloves and aprons), wipes, etc.

Waste should be put in Yellow (tiger bags) waste sacks and should not be filled more than three-quarters full

Yellow waste sacks should be secured and removed to the storage area by staff wearing non-sterile gloves and aprons

Medicines and sharps should never be placed in yellow sacks

Collection of offensive waste will be undertaken by the appointed specialist waste disposal contractor

6.4 Storage of waste before it is collected6.4.1 Storage areas for waste must be:

Clearly defined

Access controlled

Easily cleaned following collection

Secure from vermin

Not over-filled with bags

Contain no other substance or materials except the waste bags

7. SHARPS

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7.1 Sharps are defined as needles, syringes, scalpels, used medicine ampoules, razor blades and lancets, other materials which may be contaminated with body fluids or chemicals and may cause laceration or puncture of the skin in use or during disposal.

7.2 Before using sharps, ensure that there is a designated, labelled, correctly assembled used sharps container available and in a suitable location. Sharps containers must comply with BS 7320 and be situated where they cannot be assessed by vulnerable people.

7.3 All sharps must be disposed of directly into the sharps container. Where possible take the sharps container to the point of use, and place it on a hard surface, to avoid carrying unprotected sharps in busy areas.

7.4 Staff should be aware that visiting professionals, e.g. District Nurses and GPs, may also be using sharps during consultations with residents. Most of these visitors will carry their own disposal equipment but where the visitor does not they must be provided with a suitable sharps disposal container.

7.5 Needles and syringes should be disposed of as a complete unit and not disassembled unless, in the case of phlebotomy, the needle must be removed for fluid transfer. In this case, the needle should be disposed of directly into the sharps container.

7.6 It is the responsibility of the individual using a sharp to dispose of it safely:

NEVER put sharps into any bin other than the sharps disposal container

NEVER fill the sharps container more than ¾ full

NEVER leave sharps protruding from the container. If they will not drop into the container, the container is full. It should be sealed and a new disposal bin put into use

NEVER push sharps into the disposal container, this significantly increases the risk of accidental injury

When the sharps container is three-quarters full it should be sealed as instructed and left in a safe area for collection by the disposal contractor

Once sealed, sharps containers should not be re-opened.

7.7 All sharps injuries must be reported using the HCC Adult Services Incident Reporting system.

8. INFORMATION & TRAINING

8.1 Managers are expected to make suitable arrangements so that all employees receive appropriate induction training immediately they commence employment.

8.2 Employees who will regularly work with service users as part of their employment will receive training in safer techniques as part of their care training pathway. Subsequently, refresher training will be given to all employees as necessary.

8.3 The frequency and design of training required shall be identified by the outcome of audits, risk assessments and consultation with the Workforce Development team who will advise managers on the appropriate training courses available.

8.4 New employees, and particularly young persons, should not commence any duties or workplace activities until they are suitably trained or can be supervised by a competent person.

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8.5 Local records should be kept by managers to show what training individual staff members have received together with any outstanding training needs they might identify.

9. EMPLOYEE RESPONSIBILITIES

9.1 All employees have a general duty to take care of their own health, safety and welfare and that of other people who may be affected by their actions. They must co-operate with managers and:

wash their hands regularly including –o after attending any service user where direct contact is involved, no

matter how minor the contacto after handling any body fluids or waste or soiled itemso after using the toileto before handling foodstuffs

clean up any spillage of any body fluids or body waste such as blood, faeces and urine, as quickly as possible

keep the premises clean and tidy and report any areas which fall below acceptable or safe standards of cleanliness and hygiene

always use universal precautions, e.g. disposable aprons and gloves, whenever at risk of coming into direct contact with body fluids or potentially infectious materials

wherever food is prepared, handled, stored or served, employ the highest standards of hygiene at all times

always inform their managers if they are unwell with suspected food poisoning, diarrhoea, vomiting or any other infectious disease

ensure that soiled articles of clothing and infected linen are not carried through areas where food is stored, prepared, cooked or eaten

wear a clean, properly laundered uniform for each shift

co-operate with any waste segregation process implemented by the home — including the segregation of domestic and clinical waste

use recommended control measures in relation to infection control and which have been designed for their safety

report all accidents and incidents using the Adult Services incident reporting system

10. INFECTION CONTROL LEADS

10.1 The Health and Social Care Act 2008, Code of Practice for the Prevention and Control of Infections, states that adult social care organisations should designate an individual to be the lead for infection prevention and control

10.2 In Adult Services, every Provider Services establishment and team should have an Infection Control Lead person who can co-ordinate safe practice and distribute information locally.

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10.3 Infection Control Lead persons should attend the Infection Control for Managers course and discuss their requirements with Workforce Development.

10.4 In Adult Services, the Strategic Service Manager Care Governance will co-ordinate the Departmental response to infection control and monitor policy in conjunction with the Head of Health & Safety.

10.5 Where there are safeguarding concerns, these must be addressed through the safeguarding process.

11. PERFORMANCE MANAGEMENT STANDARDS

11.1 A member of staff should be nominated and empowered to act as Infection Control Lead for their Unit, Day Service or team.

11.2 Competent persons assess the risks of infection in their area of control and recordthese.

11.3 Adequate and relevant information (e.g. from risk assessments) must be provided to all staff, and other persons who are likely to be exposed, so that they can carry out

tasks without endangering their health.

11.4 Risk assessments must be reviewed on a regular basis, and whenever there isreason to believe the assessment is no longer valid, e.g. after any changes to working practices, changes in substances or after a serious incident involving a biologically hazardous substance.

11.5 Appropriate control measures to reduce the risk of injury to health must be introduced to control or reduce any exposure to biologically hazardous materials.

11.6 All staff who may be exposed to biologically hazardous materials in the course of their work must attend appropriate training.

11.7 Any information, instruction or training provided to staff must be recorded.

11.8 All staff must be provided with suitable and effective Personal Protective Equipment (PPE) where necessary.

11.9 Only products or equipment approved and specified by County Supplies, or other approved suppliers, should be used to maintain infection control.

11.10 Managers must seek help and advice from appropriate persons within the Adult Services Department, e.g. Health & Safety Advisers or Occupational Health, when they are unsure about the safety of a process or other possible effects on health.

12. INFORMATION SOURCES

Department of Health – Prevention and control of Infection in Care Homes

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https://www.wp.dh.gov.uk/publications/files/2013/02/Care-Home-Resource-Summary-Feb14-2013.pdf

Guidelines for the management of Norovirus outbreaks in acute and community health and social care settings http://www.hpa.org.uk/webc/HPAwebFile/HPAweb_C/1317131639453

Clostridium Difficile infection – How to deal with the problemhttp://www.hpa.org.uk/webc/HPAwebFile/HPAweb_C/1232006607827

Guidance on the diagnosis and management of PVL-associated Staphylococcus aureus infections (PVL-SA) in England http://www.hpa.org.uk/webc/HPAwebFile/HPAweb_C/1218699411960

Health & Social Care Act 2008 – Code of practice on prevention and control of infections and related guidance. CQC Outcome 8. http://www.dh.gov.uk/prod_consum_dh/groups/dh_digitalassets/documents/digitalasset/dh_123923.pdf

Care Quality Commission – Essential Standards of Quality and Safety.http://www.cqc.org.uk/sites/default/files/media/documents/essential_standards_of_quality_and_safety_march_2010_final_0.pdf

Health and Safety (Sharp Instruments in Healthcare) Regulations 2013http://www.hse.gov.uk/pubns/hsis7.pdf

Blood-borne viruses in the workplace – HSEhttp://www.hse.gov.uk/pubns/indg342.pdf

13. MANAGING AN OUTBREAK OF INFECTION

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13.1 An outbreak of infection is defined as “more cases of an infection than would normally be expected of the same infection in the unit”. This applies to cases related to both service users and staff and most importantly if more than two cases, which are suspected or known to be infectious, occur within a few days.

13.2 If an outbreak is suspected the manager/duty manager, as appropriate, will contact Public Health England (formerly HPA) or local Environmental Health Officer, who will verify whether or not the outbreak is valid. If so, an appropriate action plan will be agreed and must be implemented. The Service Manager must also be informed without delay and if the outbreak status is confirmed a CQC Regulation 18 report http://www.cqc.org.uk/node/2285 and an internal incident report must be made.

13.3 Following confirmation of an outbreak infected residents should be isolated wherever possible as directed. Admissions to, and transfers from, the home will have to be restricted for an agreed period of time, to help contain the infection. Visitors to infected residents will need to be restricted unless the individual is very unwell. It will also be necessary to explain the need for prevention of cross infection and methods of infection control will need to be explained verbally and by signage.

13.4 Records of all infections will need to be kept in the affected individual’s personal files and an “Infection Incident Log” should be opened containing a brief summary of what has occurred and recording all specimens sent to the local laboratory for analysis. The manager, or duty manager, will need to carry out a surveillance of hitherto unaffected service users and monitor for signs of the infection spreading.

13.5 If a food-borne infection is suspected, the local Environmental Health Officer (EHO) must be informed immediately. The EHO will need to check on the following and appropriate records and procedures which should be available for inspection:

Hygiene / cleaning procedures within the kitchen / food handling areas Records and proof of conformance to the home's Food Hygiene Practice Menus, records of food taken by service users and any retained samples of

food.

13.6 The EHO may also wish to Interview catering / food handling staff regarding their health, if necessary.

13.7 If a service user has diarrhoea their contact with other residents should be restricted. They should be cared for in their own room and designated a specific commode or toilet for their exclusive use. Faecal samples should be obtained as soon as possible from symptomatic service users and the microbiology form accompanying the sample should clearly state it is part of an outbreak. This will determine which specific tests are carried out in the laboratory.

13.8 Antibacterial alcohol gels should be used routinely during an outbreak by healthcare staff between attending to residents but hands must always be washed very thoroughly with soap and water first.

13.9 Environmental cleaning should be increased and particular attention should be paid to toilets, bathrooms, door handles, commodes and support handrails. For the duration of the outbreak, environmental cleaning should be performed using detergent and hot water followed by a chlorine-releasing solution at concentrations of 1000ppm. Disinfectants need to be used on surfaces and floors to ensure that the spread of infection is controlled.

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13.10 Soiled linen should be bagged and dealt with separately as potentially infectious according to individual care home policies and practices. Laundering of soiled bed linen or clothing should be on a hot cycle of the washing machine (at 71ºC for three minutes or more where possible).

13.11 Service users should be encouraged to wash their hands after using the toilet or commode, and before eating.

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DEPARTMENTAL DISTRIBUTION LIST

All managers

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