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Care Certificate Standards Guide » Care Certificate Standard 15 – Infection Prevention and Control

After reading this Care Certificate Standard 15 – Infection Prevention and Control, you should be able to:

  • Have a greater understanding on the types of infections
  • Have a greater understanding on hospital associated infections
  • Have a greater knowledge on the infection chain.

 

The Care Certificate Standards detail what you must achieve and be assessed against to meet these learning outcomes.

If you have any concerns or queries, you should discuss these with your employer and/or assessor.

All about infection control

An infection occurs when microorganisms (also known as ‘pathogens’ or more commonly as ‘germs’) that are not normally present invade the body of an individual where they then replicate, often very quickly. Infection can happen without the knowledge of an individual and can sometimes cause life-threatening symptoms, depending on the type of infection that has occurred.

Some infections may stay in one area of the body, which health professionals refer to as a ‘localised’ infection, whereas others can spread throughout the entire body, which are referred to as a ‘generalised’ infection.

Any person can develop any sort of infection at any time in their life, as although the human immune system deals very effectively with most pathogens, there are times when it will be unable to fight off the infection before it affects a person’s health.

Types of infection

There are three main types of infection that an individual will most likely experience at some point in their lifetime, which are:

  • Bacterial
  • Viral
  • Fungal.

 

Infections can be dangerous to individuals because they are responsible for:

  • Producing toxins
  • Reproducing rapidly, which stops parts of the body from working properly
  • Attacking and subsequently damaging a particular part of the body.

 

The severity of the infection will be dependent on each individual instance because several factors determine how unwell they will become such as their existing health and how quickly they are able to identify signs of the infection.

Bacterial infections

Some forms of bacteria are good for the body, such as those which live in the gut and keep the digestive system in good working order and keep harmful bacteria from moving in.

However, some bacteria have the potential to make people very unwell and are the cause of illnesses such as:

  • Food poisoning
  • Sexually transmitted infections
  • Urinary tract infections (UTIs)
  • Tuberculosis
  • Skin infections such as cysts and boils
  • Bacterial meningitis.

 

Bacterial infections occur when bacteria invade an individual’s body and multiply when they find favourable conditions to do so. They then release toxins, which are what make people feel unwell when they have a bacterial infection.

Signs of a bacterial infection will vary depending on the area of the body that has been infected, but some symptoms that are common to most people include:

  • Headache
  • Fever
  • Fatigue
  • A general sense of being unwell.

 

Most bacterial infections will be treated with antibiotics but some strains of bacterial infection are becoming resistant to antibiotics, which is why health professionals have been recommended to reduce the number of prescriptions they offer when people are unwell.

Viral infections

A virus is a much smaller form of pathogen than bacteria and they are able to enter the human body through any of its openings, most often via the mouth and nose. Once they have entered the body, they find a ‘host cell’ where they attach themselves and attack the body by replicating rapidly.

Examples of viral infections include:

  • Colds
  • Influenza (the ‘flu’)
  • Measles
  • Chicken pox
  • Rubella
  • Pneumonia
  • Bronchitis
  • Gastroenteritis
  • Hepatitis C
  • HIV
  • Viral meningitis.

 

Just as with bacterial infections, the symptoms of a viral infection will be very much dependent on what the virus is and what area of the body it is affecting, and many symptoms are similar to those of a bacterial infection:

  • Headache
  • Fever
  • Fatigue
  • A general sense of being unwell.

 

Viral infections, which are localised, such as a chest infection, will cause other specifically related symptoms such as a cough and difficulties with breathing.

Viral infections do not respond to antibiotics, as they are not caused by bacteria and so the virus must be destroyed by the body’s immune system. Individuals who have received vaccinations against certain diseases will be more resistant to them because their body will contain antibodies that have been naturally produced by the body to destroy the disease.

Fungal infections

Fungi are multi-celled plant-like organisms but, unlike other plants, they cannot make their own food and so they get this from plants, people and animals. A fungal infection is therefore caused when a fungus invades the body and it cannot be naturally overcome by the immune system.

Types of fungal infection include:

  • Athlete’s foot
  • Ringworm
  • Infections of the nails
  • Oral thrush
  • Vaginal yeast infections.

 

In some rare instances, fungi can invade the lungs and nervous system, which can be fatal for the individual.

Symptoms of a fungal infection include those which are common to bacterial and viral infections such as headache and fever but there are other specific symptoms as well, which will relate to the site of the infection and might include:

  • Inflamed skin
  • A skin rash
  • Oozing skin
  • Skin which is peeling and cracking
  • Itching and swelling.

 

To treat a fungal infection, medication such as creams and ointments are applied to the site of the infection. However, medication to treat this form of infection can be administered orally or intravenously, if the infection has become serious and potentially life-threatening.

Healthcare Infection Control and Prevention

The spread of infection

One of the difficulties with infections is the fact that some forms spread very easily and can lead to multiple people within a setting becoming unwell with the same illness.

This is problematic within clinical settings where infections which are extremely contagious, such as the norovirus (a severe sickness bug), can affect a lot of people within a short space of time, and this virus in particular has been known to cause hospital wards to close to visitors whilst employees try to contain it.

Most people will be able to recover from a virus with use of medication and the effects of their own immune system but some individuals are vulnerable to the effects of infection because they are already unwell, and so stopping the spread of infection is a key element of best practice within clinical and other settings to make sure that people stay as safe as possible.

Ideal conditions for bacterial growth

Bacteria need three ideal requirements in order to successfully multiply, and these can be found in any of the places noted above:

  • Warmth: some bacteria are able to survive in very hot or cold temperatures but most will thrive where there is a temperature that rests consistently between 5 and 57 degrees Celsius. This means that the human body provides an ideal environment for bacteria growth as it remains at around 37 degrees Celsius at all times. Food is also an ideal growth place for bacteria, which is why cooking it to certain temperatures is needed to kill off bacteria that might cause food poisoning.
  • Moisture: bacteria can survive for long periods without water but will need it eventually in order to survive and replicate. The human body, food and bodies of water allow bacteria to grow as these are places where water is abundant.
  • Nutrients: any place where there is a source of oxygen, nitrogen and phosphorous will allow the growth of bacteria and all of these are present in the human body.

What are the consequences of infection?

The consequences of infection vary in accordance with the type of infection that is experienced and how long an individual might live with its symptoms. For the most part, individuals will have short-term consequences of the infection, which subside once it has been successfully treated.

Some of the short-term consequences of infection can include:

  • Being physically unwell, such as having a headache, fatigue, nausea and aching muscles
  • Having a low mood due to the physical effects of the infection
  • Having to take time off from work, which may lead to some level of financial hardship
  • The temporary worsening of existing conditions, such as finding it more difficult to control blood sugar levels for people who live with diabetes
  • Passing the infection to others, which may include individuals who are not as able to fight it off.

 

Some of the long-term consequences of infection can include:

  • Sepsis (which can be caused by any form of infection) – some individuals may experience chronic pain, some have memory problems and some need to undergo amputations. Many will experience anxiety and depression due to their experience as well.
  • Gastroenteritis – some individuals will go on to develop irritable bowel syndrome or inflammatory bowel disease.
  • Sexually transmitted infections – some individuals will have their fertility affected and some women will go on to develop cervical cancer, whilst some may experience a greater risk of having an ectopic pregnancy.
  • Meningitis – some individuals will go on to experience hearing impairments, epilepsy, speech problems or paralysis.
  • Measles – some individuals will go on to have severe visual impairments, or become more susceptible to chronic ear infections.
  • Pneumonia – some individuals will have an increased risk of developing asthma and a reduce function in one or both lungs.
Infection Prevention and Control

What is asepsis?

Asepsis is “the absence of infectious organisms, such as bacteria, fungi, viruses or other microorganisms, which may cause disease.”

The use of asepsis techniques is vital in ensuring that clinical settings such as hospitals remain safe for individuals by reducing the risk of infection developing and spreading.

The NHS note six essential factors which are involved in aseptic techniques:

  • Skin preparation: although it is not possible to sterilise skin, the use of certain chemicals before procedures take place can reduce levels of bacteria on the skin. For example, before giving blood, individuals will have the site of the needle insertion fully cleaned before the procedure begins.
  • Reusable equipment: any equipment which is used more than once must be sterilised and fit for purpose. Any equipment that is single-use must be intact, in date and have no visible signs of potential contamination.
  • Hand hygiene: cited as the most important component of preventing infection, proper hand washing techniques must be employed on a regular basis and particularly when the hands are visibly dirty or they have bodily fluids on them.
  • Personal protective equipment (PPE): PPE should be used at any time when there is a risk that there will be contact with bodily fluids or at any other time when the risk of cross infection is high. Single-use PPE items should be disposed of in accordance with waste disposal policies and any items which are reusable should be thoroughly sterilised prior to a second and any subsequent usage.
  • Creating and maintaining a sterile field: this refers to ensuring that an area around a procedure site and on surfaces which will hold equipment and/or dressings are kept sterile. If contamination of an object occurs, the procedure must be abandoned and restarted.
  • Use of a safe invasive procedure: infections that occur after a procedure are more likely if techniques used to make incisions, for example, are not safe and effective.

 

(www.nhs.uk)

General recommendations for creating a safe environment

In order to ensure that an environment is as aseptic as possible, the NHS recommends the following:

  • Any invasive procedure should be carried out in a clinical room. If this is not possible the area around the individual should be prepared to reduce the risk of dust movement
  • The amount of people in a clinical space should be as low as possible
  • Surfaces within clinical spaces should be free from unnecessary clutter
  • During any procedure, doors and windows must be closed and fans switched off
  • Areas of a clinical space that may have been contaminated during a procedure should be thoroughly cleaned and disinfected before the use by another individual.

How infections are spread

There are six links in the chain of infection whereby an infection is passed from one individual to another:

  • Microorganism: these must be present for the chain of infection to begin and they can be spread directly or indirectly from person to person. Microorganisms might be bacteria, viruses or fungi.
  • Reservoir: the second link is the reservoir where a microorganism can be found. This will be a place where the microorganism has all of the requirements it needs to grow and replicate, which include warmth, moisture and nutrients. The human body provides an excellent reservoir for microorganisms.
  • Portal of exit: for infections to spread successfully, the microorganism must leave the reservoir through the third part of the chain of infection, which is an exit point, such as skin cells, breath and bodily fluids such as blood and vomit.
  • Mode of transmission: the microorganism needs a mode of transmission to get from one person to another. This might be via contact with an infected individual, ingestion of food or inhalation of air into which an infected person has sneezed, for example.
  • Portal of entry: the microorganism then gets into the other person, who becomes the fifth link in the chain of infection. They may become infected via the nose, mouth, cuts in the skin or via a piece of medical equipment.
  • Susceptible host: the final link in the chain is the individual who is at risk of infection. Anyone can develop an infection but those who are most at risk include people who are already unwell, those who are very young or very old and those whose treatment involves medical equipment.

 

Routes of entry and exit – transmission

Transmission is a way of explaining how something gets from one place to another. It is a key term in infection control because it helps with our understanding of how infections are contracted and how they are then spread to other people.

A route of entry is the way in which an infection is ‘caught’ by an individual, referring to how it enters their body.

A route of exit is the way in which the infection is transmitted to an individual and this may be done:

  • Directly
  • Indirectly.

 

Both methods of transmission can result in an individual becoming infected but the way in which they have become infected is quite different.

Direct transmission

Direct transmission occurs when there has been physical contact between two people or because infected droplets that are produced when coughing and sneezing are sprayed onto or close to someone else.

Family members and colleagues will often be susceptible to direct transmission of infection because they are in consistently close contact with others, one of whom may have some form of infection.

Other ways that direct transmission of infection can occur include:

  • The passing via the placenta from a mother to her unborn baby
  • Contact with any sort of lesion to the skin such as a cut or scratch
  • Contact with bodily fluids such as blood, saliva and vomit.

 

Indirect transmission

Indirect transmission occurs when infection is passed to an individual in any way that does not involve physical contact or from droplets that have been sprayed into the air.

Examples of some of the ways in which indirect transmission occurs include:

  • Airborne transmission: this occurs when droplets are sprayed into the air but they do not immediately disappear and remain suspended there for some time after. Measles is contractible via this method because someone with the illness may leave a room but the infection remains in the air, putting others who follow into the room at risk.
  • Contaminated objects: any form of object can be the source of infection for a short time but if an individual has touched many objects and surfaces in several places, the infection might be present on them all. Examples of objects that might cause indirect transmission include:
    – Door handles
    – Taps
    – Hand rails
    – Cutlery and crockery
    – Computer keyboards
    – Telephones
    – Light switches.
  • Food: if food has not been cooked or handled properly it becomes a source of infection because it allows bacteria to grow and multiply, which might then be ingested by an individual who then develops an infection. Water can also be the source of infection, especially if it is dirty or it is drunk in a location that an individual is new to, where it may contain bacteria that their body has never previously destroyed.
  • Vector-borne transmission: this form of transmission comes from insects, for example malaria, which is one of the most universally fatal diseases which is caused by being bitten by mosquitoes, and Lyme disease is caused by tick bites.
  • Environmental reservoirs: soil, water and vegetation can contain infectious microorganisms, which can be transferred to individuals. For example, Legionnaires’ disease is spread by water, such as in a building’s air conditioning system, which is then distributed throughout the building, potentially putting everyone at risk.
Health and Social Care Infection Control

Those most at risk from infection

Although anyone is at risk from developing an infection, there are several groups of people who are more at risk than others, which include those who are:

  • Already unwell
  • Very old
  • Very young
  • Having treatment requiring the use of medical equipment
  • Malnourished
  • Pregnant
  • Exposed consistently to infected individuals.

 

These risk factors do not mean that developing an infection is inevitable but the risk is increased, particularly for individuals who may have more than one risk factor, such as a pregnant lady who is not eating well due to extreme morning sickness or an older person who requires regular injections to keep an existing condition’s symptoms under control.

Breaking the chain of infection

The chain of infection can be successfully broken at any one of the six links that were described at the start of this unit. Health professionals recommend many ways that this can be accomplished, and these are through various methods including prevention, hygiene, policy and education.

  • Immunisations: preventing rather than curing infections is, arguably, the best way of ensuring that individuals are not affected by infections. Vaccinations do not exist for all infectious diseases but where one is available, individuals are encouraged to become vaccinated wherever it is safe for them to do so.
  • Isolation: individuals who are identified as having serious infections that are highly contagious, should be placed in isolation away from others as soon as possible. Employees who work with such individuals should be adequately trained and ensure that they are using appropriate PPE, which will be more substantial than normal.
  • Infection control policies: strict adherence to infection control policies that are clear, robust and accessible, should ensure that the risk of infection within a setting is reduced. An organisation’s infection control policy should stand up to rigorous inspection such as from the Care Quality Commission whose role is to ensure that those who provide healthcare services do so to the correct standards.
  • Hand hygiene and PPE: two of the most basic ways of breaking the chain of infection are to ensure that hand hygiene is consistent and that PPE is used in any instance where there is potential for infection from another person.
  • Appropriate disposal of waste: waste disposal is essential in ensuring that infected items such as medical equipment and linens do not put others at risk. For example, if a needle has not been disposed of properly, this does not just put the person at risk who used it but others who may come into contact with it at a later time such as a cleaner or someone who comes to collect waste from clinical settings.
  • Food safety: in order to avoid food poisoning, food should be prepared and cooked properly, at the correct temperatures, in order to prevent bacteria from growing and multiplying. Food should also be stored at the correct temperature and should not be given to individuals after its use-by date, which should be checked before preparation takes place.
  • Infection education: educating individuals and employees about the importance of hygiene and the effects of infection can help them to be self-aware about their own hygiene practices and can also help individuals to identify times when they may have an infection and therefore need to avoid contact with vulnerable individuals. Individuals who are more at risk of infections, such as those with chronic illnesses and pregnant women, would greatly benefit from learning as many strategies as possible to prevent themselves (and others) from developing an infection.
  • Appropriate use of antibiotics: as more and more infections become resistant to antibiotics, healthcare professionals are being asked to take care when prescribing antibiotics so that they are only used when it is appropriate to do so. For example, an individual who is asking to have antibiotics for a viral infection should not be prescribed them as viruses do not respond to this kind of infection.

All about infection control measures

What are microorganisms?

Most people will be familiar with microorganisms as this is another word for germs. They are organisms that are so small that it is only possible to see them with the use of a microscope, and for this reason they can easily go undetected.

Germs come in several different forms:

  • Bacteria
  • Viruses
  • Fungi.

 

Any of these three has the potential to cause significant harm to people and more so to people who may be in a clinical environment like a hospital where their immune system to protect them against germs may have already been compromised.

How can we prevent exposure to microorganisms?

Prevention of exposure to all microorganisms at all times would be all but impossible but there are measures that can be put into place to help reduce the risk of cross infection where individuals are unwell, and these are outlined as follows by the World Health Organisation:

  • Handwashing – the most fundamental aspect of ensuring the reduction in the risk of cross infection
  • Use of personal protective equipment (PPE) – such as gloves, aprons and masks
  • Sterilising equipment – equipment that is reusable should never be used on another individual until it has been cleaned and reprocessed properly
  • Environmental control – settings should have adequate procedures for the routine care, cleaning and disinfecting of environmental surfaces
  • Use of linen – any soiled linens should be disposed of in a way that does not put others at risk
  • Sharps injuries – preventing such injuries (such as from needles) by use of appropriate equipment and safety procedures
  • Isolation – individuals who may contaminate an environment should be placed away from others in a separate space.

How can we prevent exposure to microorganisms?

Prevention of exposure to all microorganisms at all times would be all but impossible but there are measures that can be put into place to help reduce the risk of cross infection where individuals are unwell, and these are outlined as follows by the World Health Organisation:

  • Handwashing – the most fundamental aspect of ensuring the reduction in the risk of cross infection
  • Use of personal protective equipment (PPE) – such as gloves, aprons and masks
  • Sterilising equipment – equipment that is reusable should never be used on another individual until it has been cleaned and reprocessed properly
  • Environmental control – settings should have adequate procedures for the routine care, cleaning and disinfecting of environmental surfaces
  • Use of linen – any soiled linens should be disposed of in a way that does not put others at risk
  • Sharps injuries – preventing such injuries (such as from needles) by use of appropriate equipment and safety procedures
  • Isolation – individuals who may contaminate an environment should be placed away from others in a separate space.

Basic hygiene procedures including handwashing

The use of basic hygiene procedures is one of the most robust ways of helping to lessen the possible spread of infection. However, this will only be possible if staff are aware of what their responsibilities are in terms of personal hygiene and handwashing procedures.

All organisations should have a policy in place about hygiene procedures and how these are best followed. It should be easily accessible to all staff who can refer to it if they have any doubts about what their own responsibilities are in lessening the risk of infection spreading within their setting.

Personal hygiene

Good levels of personal hygiene are important in the fight against infection with the following being adhered to by any employee:

  • Nails should be kept short so that they cannot harbour bacteria (and so that they do not scratch people)
  • Hair should be tied back
  • Showering or bathing should be regularly carried out
  • Hair should be washed
  • Clothing must be freshly laundered – uniforms should not be worn outside of the setting to avoid potentially infecting other locations
  • Watches and rings should not be worn as these too can provide breeding areas for bacteria
  • Hands should be washed frequently.

 

Handwashing is the most basic but important way of preventing cross infection when working with individuals and with equipment that may have been used with someone who has some form of infection.

The NHS has a standard practice for the best way to wash hands to ensure that they no longer potentially contain harmful bacteria and this should be done both before and after sharps have been used with individuals.

You should wash your hands for the amount of time it takes to sing ‘Happy Birthday’ twice (around 20 seconds)

  • Wet your hands with water
  • Apply enough soap to cover all over your hands. You can use alcohol-based handrub if you don’t have immediate access to soap and water
  • Rub hands palm to palm
  • Rub the back of your left hand with your right palm with interlaced fingers. Repeat with other hand
  • Rub palms together with fingers interlaced
  • Rub the backs of your fingers against your palms with fingers interlocked
  • Clasp your left thumb with your right hand and rub in rotation. Repeat with your left hand and right thumb
  • Rub the tips of your fingers in the other palm in a circular motion, going backward and forwards. Repeat with the other hand
  • Rinse hands with water
  • Dry thoroughly, ideally with a disposable towel
  • Use the disposable towel to turn off the tap.

Effective cleaning procedures

Every setting will have slightly different cleaning procedures but most will adhere to something similar to the following:

  • Floors should be cleaned of debris before using a detergent solution
  • Detergent residue should be cleaned off once a detergent has been used
  • Methods of using detergents that create mist or those that disperse dust should be avoided
  • Vacuum cleaners should have filters removed and changed regularly
  • Any areas classed as ‘high touch’ should be cleaned thoroughly on a daily basis and should be visibly clean at all times
  • Detergents and other cleaning materials should be locked away
  • Mops should be thoroughly cleaned and detergents should not be mixed in mop buckets
  • Water from a mop bucket should be emptied out in an appropriate place.

 

Only staff who are trained to use specific pieces of equipment and potentially dangerous chemicals should use them and no one else, as not only does this increase the risk of cross infection but the risk to safety in general as well.

Infection Control Care Certificate Standard 15

Dealing with spillages

Spills of body waste may occur, for example, if an individual does not get a receptacle for vomit in time or if they enter an A&E department bleeding profusely from a wound. Employees are also responsible for dealing with the contents of bottles, bedpans and commodes, where there is a greater potential for spillages to occur. When a spill occurs, it should be dealt with immediately and appropriately with suitable cleaning materials by employees who are trained in their use.

Recommended methods of dealing with spillages

It is important that employees are wearing PPE when dealing with any type of body fluid spillage so as to reduce the risk of infection. This means wearing a minimum of an apron and gloves, which should be disposed of immediately after use.

After PPE has been put on, employees should clear the spillage as quickly as they can, ensuring that no one else comes into contact with it wherever this is possible, so making others aware of the spill by use of a sign or by simply telling them to avoid the area if they can.

The area that is in and around where the spillage has occurred should then be cleaned using specific cleaning materials and equipment, which the Health and Safety Executive makes clear recommendations about:

  • Cleaning materials and equipment for removing spilled body fluids must be used for no other purpose; they must be specifically for body waste and nothing else
  • A hypochlorite solution, which contains chlorine releasing disinfectant, is most suitable for this type of spillage
  • Bags and bins for the waste which comes from the cleaning up of body waste must be clearly labelled and employees must know which one to use
  • Employees must ensure that they dispose of their own PPE in the correct place and thoroughly wash and dry their hands after dealing with spillages – they should not come into contact with anyone else before washing their hands.

 

After a spillage has been cleaned up

Whilst the spillage is being cleaned up, the Health and Safety Executive also recommends:

  • Ensuring that there is adequate ventilation in the area
  • Ensuring that a warning sign is put up where the bodily fluid has been spilled to warn others, and not removing the sign until the spillage has been fully dealt with
  • Ensuring that any residue, which is scraped up, is disposed of in a closable container ready for safe disposal in the appropriate waste area
  • Ensuring that any linens that have been soiled are put in appropriate bags for laundering
  • Any place where a spillage that has taken place in an individual’s home where it may have seeped into a carpet must be thoroughly disinfected.

Effective use of personal protective equipment (PPE)

PPE is any form of equipment that will protect its user against health or safety risks whilst at work, which includes potential cross infection.

Making the workplace safe means that organisations are responsible for providing instructions, procedures, training and supervision to encourage people to work safely and responsibly, including using PPE to protect themselves whilst working with individuals who are known to be or who are potentially unwell.

Organisations should be clear about when PPE is required and never deviate from the rules, for example telling a nurse that she needn’t wear gloves because the procedure will ‘only take a few seconds’ or telling a care assistant that he needn’t get an apron because ‘the individual’s symptoms have subsided’.

Deviation from the rules about PPE places employees at risk and when working with people who are seriously ill, this can mean that there is potential for the employer to become seriously ill as well.

Using PPE

PPE is a vital part of ensuring that employees are not exposed to potential harmful bacteria whilst carrying out their role. It should be worn on any occasion where there is a possibility that they may come into contact with body fluids, and this can occur with any form of contact with an individual.

Employers are legally required to provide PPE to all employees who will need it when carrying out their role.

  • Gloves: gloves should be put on before any task where there may be contact with body fluid. They must then be removed immediately upon its completion. Employees should ensure that individuals are not allergic to latex before assisting with any procedure that involves direct contact with an individual, as most gloves that are used in a healthcare setting are made from this material and an alternative material must be made available by the employer.
  • Overshoes: these are worn to prevent the transmission of infection via flooring. They are used most commonly in a clinical environment when employees are working with individuals who have had surgical procedures or those who may have been placed in isolation.
  • Aprons: aprons, like gloves, should be worn when carrying out any task where there is a possibility of coming into contact with body fluids. They should be removed immediately after the task has been completed and disposed of in the correct manner, in line with official guidance.
  • Masks or eye protectors: although it is less common that an employee would need to use some form of face protection, this is important when working with an individual who may have some form of infection, or where there is the possibility that the employee’s face or eyes may be splashed with some form of body fluid.

Effective waste disposal

As well as taking care when a procedure is taking place, it is also imperative to maintain high levels of care when it has finished, which includes ensuring that waste is disposed of in the most appropriate and effective manner. All organisations should have strict waste disposal policies in place, which, like other policies, should be robust, accessible and not subject to misinterpretation.

Waste disposal can sound like a complicated business because there are rules for what seems like a very large number of different types of waste. However, the rules are actually quite simple and easy to adhere to. Should employees have any doubts about the way in which they dispose of waste, they should always seek guidance from a supervisor or manager and never guess what to do, as this could have serious consequences.

What is clinical waste?

Clinical waste is the term used to describe any waste product that is generated by healthcare and similar activities that might go on to pose a risk of infection, for example needles and other types of sharp.

The full definition, which comes from the Controlled Waste Regulations, states that clinical waste is:

“a. any waste which consists wholly or partly of human or animal tissue, blood or other body fluids, excretions, drugs or other pharmaceutical products, swabs or dressings, syringes, needles or other sharp instruments, being waste which unless rendered safe may prove hazardous to any person coming into contact with it; and

b. any other waste arising from medical, nursing, dental, veterinary, pharmaceutical or similar practice, investigation, treatment, care, teaching or research, or the collection of blood for transfusion, being waste which may cause infection to any person coming into contact with it.”

The separation of waste in line with regulations and legislation

Waste must be appropriately separated so that it does not potentially cause cross contamination, and so there are specific bags into which waste should be placed:

  • Black bags: domestic waste such as food and other items that would be classed as household
  • Black and yellow bags (sometimes the bags are just yellow): items that may be contaminated with blood or bodily fluids that need to be incinerated
  • Orange bags: waste that might be infected but which may be treated to render it safe
  • Sharps waste: these must be placed into a sharps container and appropriate arrangements made for their collection.

 

Recommendations for good waste disposal practice

In terms of how employees should dispose of waste, it is recommended that they should not:

  • Fill bags more than two thirds full
  • Handle a bag by any part of it other than the neck
  • Remove any tags from the bags that show their contents
  • Hold bags against their body when moving them from place to place
  • Mix up the contents of bags unless they are mixed waste
  • Allow waste to build up, as this can begin to smell and to pose a risk to those who are close to it.

 

The policy drawn up by the employer, however, should relate to evidence of good practice, such as:

  • Waste bins should be operated by foot pedals
  • PPE should be worn when collecting waste and emptying and cleaning bins
  • Waste should be stored safely away from members of the public (particularly children), animals or pests such as rats, particularly when awaiting collection
  • Sharps bins are stored off the floor but below shoulder height and should never be placed inside domestic waste bags
  • Schedules for emptying bins should be in place and strictly adhered to.

 

Disposing of sharps

The safe disposal of sharps is just as important as their usage and there are strict guidelines based on legislation that dictates how this should be carried out. In a clinical setting, recommendations should be given in the organisation’s policy and in other settings, such as the homes of individuals, guidance is given from professional bodies such as the NHS so that employees and individuals are both able to dispose of sharps safely.

In a clinical setting, sharps must be placed directly into a sharps bin once they have been used. It is important that the bin is easily accessible once a procedure has been carried out and the bin should be as close as possible to the employee so that they do not have to walk with a sharp, which increases the length of time it is held and therefore increases the risk that it will cause injury.

Employees should ensure that all aspects of good practice are carried out when disposing of sharps so that they do not put others at risk as well as themselves, for example putting a sharp in a waste container that is not safe and therefore exposing it to someone who may then collect that container at a later time.

Disposing of sharps in other settings – sharps bins

Just like in a clinical setting, a sharps bin should be used to dispose of needles and other sharps. The sharps bin is available to individuals on a prescription but a travelling employee should have access to their own sharps bin, which is safely stored so that they can use it at several different locations with different individuals.

Sharps bins can be used to dispose of medical sharps such as:

  • Needles
  • Syringes
  • Lancets
  • Clippers.

 

Used needles should not be bent or broken before disposal and they should never be recapped, as this exposes the individual to increased risk of a needle-stick injury, increasing their risk of cross infection.

Everything you need to know about assessing and reporting breaches

Healthcare associated infections (HCAIs) also known as ‘hospital associated infections’ (HAIs) are infections that can develop either as a result of healthcare interventions such as medical treatment or surgery, or from being in contact with a healthcare setting where there is contamination. It is thought that the most common reasons for HCAIs are poor handwashing procedures by employees, contaminated equipment and not adhering to local policies and procedures.

The infection that occurs in the healthcare setting would not have been present before the individual entered the setting. Individuals who visit healthcare settings may be more vulnerable to a HCAI due to their existing illness, age or the treatment that they need for their illness.

Some infections are caused by microorganisms that are already present in the individual’s own body, which then cause problems due to a weakened immune system, or when the individual is subject to an invasive medical procedure.

HCAIs affect both individuals who visit or who are temporarily resident in healthcare settings and the employees who work within them as well.

Examples of HCAIs

  • MRSA: this is a type of bacteria that is resistant to several of the most widely prescribed antibiotics. This means that any infection caused by MRSA is harder to treat than most other bacterial infections. It mainly affects people who are staying in healthcare settings, such as hospitals, because the bacteria can enter their body during a procedure that is invasive and because they may already have other health problems, which makes it more difficult to fight off the bacteria.
  • C. difficile: also known as C.diff or clostridium difficile, this is a bacteria that can infect the bowel and causes diarrhoea. It most commonly affects individuals who have been taking antibiotics and is spread very easily to other people. The infection can lead to significant problems with bowels but can usually be treated with antibiotics.
  • E. coli.: this is a bacteria that is highly contagious and can be spread in a healthcare setting where there are large groups of people. The bacteria can cause a range of infections such as urinary tract infections, cystitis and intestinal infection.

 

Statistics about HCAIs

The rates of infection of the three most common forms of HCAI are closely monitored by the Nuffield Trust who carry out research and analysis in healthcare related fields.

The latest statistics about the prevalence of MRSA, C. difficile and E.coli are outlined below:

  • MRSA: between 2007 and 2014 there was an 82% reduction in overall rates of MRSA, before a slight increase in 2015. In the year 2017-2018, there was another 13% decrease in rates compared to the previous year, meaning that hospital related cases were less than 1,000.
  • C. difficile: during the year 2013-2014, cases of illness relating to this bacteria were at their lowest since 2007, with a rate of 13,362 for both hospital and community-based cases. After this, rates have fluctuated with the latest hospital figures for 2017-2018 showing 4,739 cases that occurred in a hospital setting.
  • E. coli.: between 2012 and 2017, there was a steady increase in cases of infection caused by E.coli in the community (where it increased by 27%). However, rates in hospital rose only by 2%, which reflects higher rates of blood testing due to increased awareness of sepsis.

 

Consequences of HCAIs

It is thought that approximately 8 in 100 individuals will develop a HCAI during care and treatment and that 5,000 individuals will die each year as a result. Other individuals who develop HCAIs are subject to longer stays in hospital, have additional pain and anxiety and may face long-term disability. It may also mean that individuals lose confidence in the NHS, particularly in the setting where their infection was contracted.

Healthcare employees may need to take time off work when they become infected, which can mean that resources in settings become overstretched. The overall cost of HCAIs to the NHS is thought to be in the region of around £1 billion per year. This is because individuals with infections cost around three times more to treat than uninfected individuals and they spend an average of 11 days more in a hospital setting.

Infection Prevention and Control Standard 15 Care Certificate

The legal requirements associated with infection control

The legislation that is associated with infection control is based around prevention and control and relates largely to general health and safety procedures within the setting.

Health and Safety at Work etc. Act 1974

An employer has a legal responsibility, under the Health and Safety at Work etc. Act 1974, to ensure that everyone who works within its organisation is protected from harm. In a healthcare setting, employers also have very strict Codes of Practice, which must be adhered to in order to ensure the safety and protection of all individuals who use their services.

The consequences for failing to adhere to Codes of Practice can be very serious for employers. For example, they may be sued by an individual or their family, or they may be reported to a regulator such as the Care Quality Commission who have the authority to put them into special measures, where their performance will be closely monitored for improvement or, in extreme circumstances, to stop them practising as an organisation altogether.

The demands of an employer, therefore, are to make sure that employees are carrying out their duty of care to individuals, whilst also keeping within legal guidelines of responsible practice and, as such, are not putting anyone who uses their services at unnecessary risk.

Reporting of Injuries, Diseases and Dangerous Occurrences Regulations (RIDDOR) 2013

This piece of legislation maintains that any setting must report deaths, major injuries, injuries that result in an absence from work for more than three days, diseases and dangerous occurrences. All reports must be made in writing but those which result in death or concern a serious dangerous occurrence must be made by phone as well.

The Public Health (Control of Diseases) Act 1984

This Act requires that doctors notify the ‘proper office’ of the local authority of any individual that he or she believes has a notifiable disease.

Some examples of notifiable diseases include:

  • Meningitis
  • Food poisoning
  • Malaria
  • Mumps
  • Measles
  • Rubella
  • SARS
  • Tuberculosis
  • COVID
  • Whooping cough.

 

Please note that this list is not exhaustive.

Control of Substances Hazardous to Health (COSHH) 2002

In all healthcare settings there will likely be a lot of equipment and medication, which can be very dangerous if ingested or touched. COSHH regulations state that all products should be included in part of a risk assessment to ensure that appropriate measures are put into place to ensure that they are not accessible in a way that will cause harm.

COSSH regulations apply to both individuals who use services and the staff who work within them to ensure that everyone is adequately protected.

The Food Safety and Hygiene (England) Regulations 2013 and Food Safety Act 1990

The Food Safety and Hygiene (England) Regulations 2013

The food hygiene regulations impose requirements on food business operators to ensure that food is safe for human consumption and to enforce food hygiene requirements that are set out in EC regulations.

Food Safety Act 1990

This Act ensures that any food served within a setting must meet appropriate food safety requirements. It also states that anyone who handles food within a setting must have appropriate training in food hygiene.

Regulatory bodies

  • The Health and Safety Executive (HSE): the HSE is an independent regulatory body whose role is to provide advice and guidance to employers in order to reduce the possibility of accidents occurring in the workplace such as those related to the spread of infection.
  • The National Institute for Health and Clinical Excellence (NICE): NICE is responsible for providing guidance on the most effective ways to prevent, diagnose and treat diseases, which includes infections.
  • The Food Standards Agency (FSA): the FSA is responsible for food safety and food hygiene and provides recommendations and advice about food safety issues.

What are the employee’s responsibilities regarding infection control?

The recommendations in legislation concerning employee responsibilities are general and are covered in the bigger picture by the Health and Safety at Work etc. Act 1974, which asserts that employees are responsible for:

  • Taking reasonable care of their own health and safety
  • Taking reasonable care not to put other people at risk in the course of their work
  • Cooperating with their employer, making sure that they get proper training and that they understand all relevant policies and procedures
  • Not interfering with or misusing anything that has been provided for their health, safety or welfare
  • Reporting any injuries or illnesses that are experienced as a result of doing their job
  • Telling their employer if something happens which affects their ability to work
  • Using PPE where this has been provided.

What are the employer’s responsibilities regarding infection control?

It is the responsibility of the employer to ensure that their employees are protected whilst at work.

Their responsibilities in terms of infection control include:

  • Providing PPE for all employees who come into contact with individuals where there is a chance of cross infection
  • Providing information to all employees about infection control policies, procedures and updates, which ensure that employees are able to carry out best practice
  • Ensuring Information is given to employees about current infection outbreaks or increased risks
  • Ensuring that staff are able to attend training and are adequately supervised where appropriate so that infection control guidelines are sufficiently adhered to
  • Ensuring that risk assessments are carried out and that strategies are put into place to minimise or eradicate any risks that are identified.

Carrying out risk assessments

Employers are responsible for assessing risks and preventing exposure to hazards as far as this is reasonably possible. The NHS base their risk assessment procedure on the Health and Safety Executive’s commonly used ‘Five Steps to Risk Assessment’, which is straightforward to follow and can be applied to infection control.

The five steps that are covered within this risk assessment are:

  • Step 1 – identify the hazards
  • Step 2 – decide who might be harmed and how
  • Step 3 – evaluate the risks and decide on precautions
  • Step 4 – record the findings and implement them
  • Step 5 – monitor performance and review.
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