Community Infection Control Policy For East London

This Policy has been agreed by the Control and Prevention of Infection Working Group and the Clinical Governance Group City and Hackney Teaching Primary Care Trust

Contents

Policy Statement 3

Local Contacts 5

Policy No. 1 Standard Infection Control Precautions Definition 7 Roles & Responsibilities 7 Supporting Literature 8

Policy No. 2 Hand Hygiene Introduction 9 Roles & Responsibilities 9 Facilities 10 Hand Hygiene Solutions 10 When & How 11 Hand Drying 13 Community Considerations 13 Look after your Hands 14 Supporting Literature 14

Policy No. 3 Use of Protective Clothing Introduction 15 Roles & Responsibilities 15 General Good Practice 16 Gloves 16 Aprons 18 Eye Protection 19 Masks 20 Footwear 20 Uniforms and White Coats 21 Personal Clothing 21 Supporting Literature 21

Policy No. 4 Occupational Health & the Control of Infection Introduction 23 Occupational Health and the Control of Infection 23 Occupational Health Services 24 Supporting Literature 24

Policy No. 5 Prevention of Sharps Injury Responsibilities 25 Good Practice 25 Supporting Literature 27

Policy No. 6 Management of Sharps, Needlestick and Splashing Incidents Definition 28 Roles & Responsibilities 28 Community Infection Control Policy 2008

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Occupational Health 28 Supporting Literature 29 Action Sheet for CHPCT, 30 Action Sheet for General Medical Practitioners 31 Action Sheet for General Dental Practitioners 32 Policy No. 7 Management of Healthcare Equipment Introduction 33 Single Use and Single Patient/Client Use Devices 33 Roles & Responsibilities 34 Purchase of Healthcare Equipment 34 Storage of Healthcare Equipment 35 Decontamination 35 Decontamination of Equipment A-Z 36 Supporting Literature 47

Policy No. 8 Management of Waste Introduction 48 Waste Definitions 48 Segregation of Waste 49 Roles and Responsibilities 49 General Good Practice 50 Storage and Transport 50 Disposal of Healthcare Waste generated in Patients/Clients’ Homes 51 Disposal of Sharps used in Patients/Clients Homes 52 Supporting Literature 53

Policy No. 9 Management of Spillages of Blood and/or Body Fluids Introduction 54 Roles & Responsibilities 54 General Good Practice 55 Cleaning of Spillages of Blood and/or Body Fluids 55 Spillage Kit 56 Supporting Literature 57

Policy No. 10 Managing the Environment Introduction 58 Roles & Responsibilities 58 General Good Practice 59 Supporting Literature 59 Appendices

Appendix 1 Reporting Outbreaks and/or Unusual Incidents 61 Appendix 2 Storage of Vaccines 62 Appendix 3 Food Handlers 65 Appendix 4 Care of Central Venous Devices in the Community 68 Appendix 5 Enteral Feeding in the Community 71 Appendix 6 Handling and Collection of Specimens 74 Appendix 7 Guidelines for Cleaning the Propulse Ear Syringing Machine 77 Appendix 8 Toys and Therapy Services 79 Appendix 9 The Use of Bench-top Sterilisers 82 Appendix 10 Notification of Infectious Diseases 88 Community Infection Control Policy 2008

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Infection Control Policy Statement

Planned Review: November 2009

Review November 2009 Approval/Adopted: 2008

Distribution: All Managers, Consultants, Heads of Service, Directors, Trust Secretary; etc.

Related Policies: Control Manual (Policies nos. 1-10 and related appendices) as shown on the contents page

Author/Further Information: Victor Oladele – Consultant Nurse Infection Prevention and Control 020 8223 8009 This Document Replaces: This policy replaces all previous community infection control policy documents of City & Hackney Community NHS Trust (CHPCT), Newham Community Primary Care Trust (NPCT), Tower Hamlets Primary Care Trust (THPCT); General Medical Practice and General Dental Practice working with these organisations.

1. Introduction 1.1 Infection Control is a core part of an effective risk management programme, aiming to improve the quality of patient care and the occupational health of staff. In addition to the clinical need to prevent HCAI, there are legal requirements to protect patients, staff and visitors from harm.

1.2 It is the intention of the Infection Control Team (ICT) covering THPCT, NPCT and CHPCT to promote the control of infection within all healthcare facilities in these areas and to act as a resource for both healthcare staff and the general public within the Trust. In order to achieve this, the Trusts accepts that the implementation of an effective Infection Control policy will enable it to work towards reducing risks to all persons affected by the Trust's activities.

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2. Purpose 2.1 The aim of this policy is to ensure that the Trust maintains effective arrangements for Infection Control, recognising the role of the Infection Control Team within the Trust’s risk management and clinical governance framework. Arrangements for Infection Control should centre on an annual Infection Control programme with defined objectives, regular review and managerial support to ensure that the programme can be implemented. This policy statement is designed to outline the resources and infrastructure in place to reduce Healthcare Associated Infection (HAI) at City and Hackney PCT. It also details how the Trust will deal with the broad and complex issues with regard to infection control.

3. Application/To Whom the Policy Applies 3.1 This policy applies to all those working in the Trust, in whatever capacity. A failure to follow the requirements of the policy may result in investigation and management action being taken as considered appropriate. This may include formal action in line with the Trust's disciplinary or capability procedures for Trust employees; and other action in relation to other workers, which may result in the termination of an assignment, placement, secondment or honorary arrangement.

3.2 Staff of CHPCT, working in care settings managed by Bart’s and the London NHS Trust (BLT), Homerton Hospital NHS Trust; Newham University Hospital NHS trust (NUH) and/or North East London Mental Health Trust (NEMLHT) should follow the Infection Control Policy of the organisation managing the care setting

3.3 This policy does not apply to staff employed by nursing and/or residential homes in East London. Staff working in these areas should refer to their manager and/or the Health Protection Agency (see Local Contacts, Page 5)

3.4 This policy must be regarded as a guide to best practice, but given the complexities of delivering care in the Primary Care setting Practitioners are urged to seek further advice in the application of this guidance at the point of care as necessary – (see Local Contacts, Page 5)

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Local Contacts

Planned Review: November 2009 City & Hackney Job Title Name Address & Contact Details Director of Infection Mary Clarke CBE St Leonard’s Hospital, Block A, 1st Floor, Nuttall Prevention & Control Street, London, N1 5LZ Director of Nursing  020 7683 5063  [email protected]  07970 711 335 Health Protection Agency Nurse Consultant Health Sarah Addiman Health Protection Unit Protection N. East & N. Central London 7th Floor, Holborn Gate, 330 High Holborn, London,WC1V 7PP 020 7759 2860  [email protected]  020 7759 2788 Medical Director Lesley Mountford  [email protected]  0207 683 4355 Infection Control Dr Albert Misfud  [email protected] Doctor  0208 535 6638 Consultant Nurse Victor Oladele Mile End Hospital Community Infection 3rd Floor, Beaumont House Prevention and Control Bancroft Road, London E1 4DG  020 8223 8437  [email protected]  07976 134 060 Quality Improvement Karen Gordon St Leonard’s Hospital, Block A, 1st Floor, Nuttall Manager Street, London, N1 5LZ  020 7683 5070  [email protected]  07904 631 123 Community Infection Mahamad (Salim) Mile End Hospital Control Nurse for City & Khodabaccus 3rd Floor, Beaumont House Hackney Bancroft Road, London E1 4DG  0208 223 8225  [email protected]  07976 134 070 Community Infection Meri Awudu Mile End Hospital Control Team Joella Lucas 3rd floor Beaumont House Bancroft Road, London E1 4DG  020 8223 8009  [email protected]  07976 134 090  [email protected]  07966 089 025

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Infectious Diseases Demi Lyem Environmental Division Clerk 81 Downham Road London N1 5TR Principal Environmental Richard Robinson & Ken  020 8356 4528 Officers Marshall  [email protected]  [email protected]  [email protected] Microbiologist Dr Daniel Krahe Microbiology Dept Homerton University Hospital NHS Foundation Trust, Homerton Row, London, E9 6SR  020 8510 7181  [email protected] Cliniserve Andy Higgins Cliniserve (Clinical Waste Vinnetrow Business Park, Vinnetrow Road Collection Company) Chichester, West Sussex PO 21 RW  01243 782 288 extn: 211  [email protected]  0845 389 396  07919 320 832 Occupational Health Mark Hopwood ,Barts & The London NHS Trust Taffy Musungwa ,Occupational Health Department ,KGV Wing, 2nd Floor, Reece Mogg Unit West Smithfield, London EC1A 7BE  [email protected]  020 7601 8070  [email protected]  020 7601 8070 Principal Pharmacist Jonathan Mason St Leonard’s Hospital, Louis Freedman Building, (Head of Prescribing and Nuttall Street, London, N1 5LZ Pharmacy)  [email protected]  020 7683 4454 Risk Management Nicholas Swietlik St Leonard’s Hospital, Block A, 1st Floor Manager Nuttall Street, London, N1 5LZ  020 7683 4482  [email protected]  07904 361123 Interim Facilities Paul Theocleous St Leonard’s Hospital, Block A, 1st Floor, Manager Nuttall Street, London, N1 5LZ  [email protected]  020 7683 4423/4216 Assistant Facilities Brenda Hughes-Mason  [email protected] Manager  020 7683 4757 Domestic Managers Jean Thomas  [email protected]  020 7683 4758 Nike Adekoya  [email protected]  020 7683 4023

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Standard Infection Control Precautions Community Infection Control Policy No: 1 Planned Review: November 2009

1. Definition 1.1 Standard Infection Control Precautions (formerly known as Universal Precautions) are a range of infection control practices designed to reduce the risk of cross contamination from one person to another, or from contaminated equipment, thereby reducing the risk of healthcare associated infection.

1.2 Standard Infection Control Precautions must be applied at all times in the care of the patient/client, regardless of diagnosis or presumed infectious status and when in contact with contaminated equipment. They must be applied when in contact with:

 Blood  Body Fluids – Excretions (e.g. urine, vomit, faeces – not sweat). Secretions (e.g. mucous, seminal fluid, vaginal fluid, lactations, saliva). Other body fluids (e.g. serum, lymph & cerebrospinal fluids).  Non intact skin  Mucous membranes (e.g. Eyes)

1.3 Standard Infection Control Precautions include:  Hand Hygiene.  Use of protective clothing (Personal Protective Equipment – PPE).  The prevention of sharps injury.  Management of sharps, needlestick /splashing incidents.  Management of healthcare equipment.  Management of waste.  Management of spillages of blood and/or body fluids.  Managing the environment

1.4 Standard Infection Control Precautions are also directly applicable to the care settings environments of staff and their practice.

2. Roles and Responsibilities 2.1 It is the responsibility of all staff to:  Complete a risk assessment prior to each task, taking account of the anticipated risk of exposure to blood or body fluids, and to select and use the appropriate protective clothing.  Secure the Hepatitis B vaccine.  Apply Standard Infection Control Precautions.

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 Cover breaks in skin with a waterproof dressing whilst on duty.  Receive training in Standard Infection Control Precautions.  Report any incidents involving exposure to blood or body fluids in accordance with the Accident and Incident Reporting Policy of each PCT.

2.2 Each PCT and Independent Contractor, as employers, are responsible for:  The provision of Hepatitis B vaccination, followed by a titre check to establish immune status, free of charge to their staff at risk of exposure to blood and body fluids in the course of their duties.  Ensuring that all staff have access to appropriate protective clothing.  Ensuring that all staff receive training in Standard Infection Control Precautions.  Ensuring that all employees, in all settings, have access to materials that will allow effective hand hygiene to take place.

Guidance on the application of Standard Infection Control Precautions is outlined in the relevant sections of this policy.

3. Supporting Literature 3.1 Department of Health, 2006. The Health Act 2006. Code of Practice for the Prevention and Control of Healthcare Associated Infections. London. Department of Health 2006, Essential Steps to Safe, Clean Care: Reducing healthcare associated infection. London. Department of Health 2003, Winning Ways: working together to reduce healthcare associated infections. Report from the Chief Medical Officer. London. Pratt RJ, Pellowe CM; Wilson JA; Loveday HP; Harper PJ; Jones SR; McDougall C; Wilcox M; 2007, epic 2 – national evidence based guidelines for preventing healthcare associated infections in NHS Hospitals in England. Journal of Hospital Infection. 65 S1-64. National Institute for Clinical Excellence 2003. Infection Control: Prevention of healthcare associated infection in Primary and Community care. London.

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Hand Hygiene Community Infection Control Policy No: 2 Planned Review: November 2009

1. Introduction 1.1 Hands are the most common way in which micro organisms, particularly bacteria, can be transferred and subsequently cause infection. Effective hand hygiene is the single most important procedure for significantly reducing/preventing infection, leading to improved patient morbidity/mortality rates.

1.2 Micro organisms on the hands are either resident or transient flora.

1.2.1 Resident flora – are usually of low virulence and rarely cause infections except when introduced into the body through invasive procedures e.g. insertion of intravenous devices, urinary catheters, or surgical procedures.

1.2.2 Transient Flora - may consist of many different pathogenic micro organisms. They are not firmly attached to the skin and can usually be removed quickly and effectively by good hand hygiene practice. The purpose of most hand hygiene in clinical settings is to remove transient flora (microbial contamination).

2. Responsibilities 2.1 All Staff  All staff groups have a responsibility to carry out hand hygiene according to best practice outlined in this policy.  Have a responsibility to report any adverse skin irritation thought to be associated with use of hand hygiene solutions to the appropriate Occupational Health Department (see Local Contacts, page 5).  Must attend yearly updates on all aspects of hand hygiene.  Must ensure that patient/clients are given the opportunity to carry out hand hygiene effectively.

2.2 Managers  Must ensure that resources to carry out correct hand hygiene practice are available at all times.  Must review, in collaboration with the Infection Control Team, incidents relating to inadequate hand hygiene and ensure that remedial action (where necessary) is taken in a timely manner.  Have a responsibility ensure that local risk assessments related to the elements of hand hygiene are carried out where necessary.  Have a responsibility to ensure that all staff attend yearly training on hand hygiene.

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Facilities 3.1 Hand hygiene sinks  Hand hygiene sinks (used for this purpose only) must be available in all clinical rooms/areas.  Hand hygiene sinks must be fitted with elbow operated mixer or sensor mixer taps. All taps must comply with HTM64 guidance.  Liquid soap must be sited immediately adjacent to the sink and dispensed via a wall mounted non-refillable dispenser cartridge.  Disposable paper hand towels must be sited immediately adjacent to the sink and dispensed via a wall mounted dispenser.  Hand hygiene sinks must not be fitted with plugs.

3.2 Alcohol- based hand rubs/gels  Alcohol based hand rubs must be available at: The entrance to all clinical areas; in each clinical room; and in individual tubes to be carried by all practitioners whose duties involve moving between sites and/or visiting patients/clients in settings outside healthcare premises.  Posters/leaflets outlining the importance of hand hygiene, both hand washing with liquid soap and water and the use of alcohol based hand rubs must be clearly displayed in all areas.

3.3 Bar soap and Nailbrushes  Bar soap is not acceptable in any clinical area as it easily becomes contaminated and acts as a reservoir for micro organisms.  Nailbrushes must not be used during routine hand hygiene.

3. Hand Hygiene Solutions 4.1 Liquid soap and water  Washing hands with a liquid soap containing an emollient will remove dirt, organic material and transient micro organisms, this level of hand hygiene is sufficient for most clinical settings in the community, the exceptions to this being prior to minor surgery and clinical dentistry.

4.2 Alcohol based hand rubs/gels  Alcohol based hand decontaminants have an important role to play in hand hygiene in situations where it is not possible to wash hands with liquid soap and water or when the volume of patient/clients and nature of intervention means that hand washing is unlikely to happen after each patient/client contact e.g. immunisation sessions.  Alcohol is not effective against some micro organisms such as Clostridium difficile, and will not remove dirt or organic material from hands.  Hands must be washed with liquid soap and water after several consecutive applications of alcohol hand rub/gel.

4.3 Antiseptic hand hygiene solutions Community Infection Control Policy 2008

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 Antiseptic hand washing solutions must not be used routinely for hand washing.  The use of such products must be limited to prior to surgical procedures and during clinical dentistry, or on the specific advice of the Community Infection Control Team.  Prolonged, repeated use of products of this type can damage the skin.

4. When and How 5.1 When  Hands must be decontaminated immediately before each and every episode of direct patient/client contact/care and after any activity or contact that results in hands potentially becoming contaminated.

Decontaminate hands Direct contact with patient/client’s skin BEFORE: Contact with invasive devices Contact with dressings Eating and/or drinking Serving food Helping patient/client/clients to eat or drink Decontaminate hands Completing episodes of patient/client care AFTER: Removal of gloves, or other protective clothing Eating and/or drinking Contact with patient surroundings After body fluid exposure risk

5.2 How  See diagram on following page.

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 An effective hand washing technique involves four stages: preparation, washing, rinsing and drying. Preparation requires wetting hands under warm running water before applying liquid soap. Hands must be washed as shown in figure 1. Ensure that the hand wash solution comes into contact with all surfaces of the hand. This should take a minimum of 10-15 seconds.  If an alcohol hand rub solution is to be used for decontamination of the hands, remember that the solution/gel must come into contact with all surfaces of the hand. The method illustrated in Figure 1 must be followed. Hands must be rubbed until the alcohol rub/gel has evaporated and the hands are dry.  Alcohol hand rub must not be used immediately following handwashing as this can damage the hands and it must not be used as liquid hand soap.

5.3 Fingernails  Fingernails must be kept short and clean  Nail polish must not be worn by staff that has direct patient/client contact.  Artificial nails/nail extensions must not be worn by staff providing direct patient/client care.

5.4 Jewellery  Wrist and hand jewellery must not be worn by staff providing personal care and/or conducting clinical interventions with patient/clients. Please refer to local Uniform Policy.  A plain band, e.g. wedding band, can be worn, but this must be removed when hand hygiene is being performed in order to remove transient bacteria which can harbour underneath such bands.

6. Hand Drying  Careful hand drying after hand washing with liquid soap and water is important so as to avoid damage to skin as a result of damp skin.  Disposable paper hand towels must be used for hand drying.  When using alcohol hand rub/gel the hands must be rubbed together vigorously, (paying particular attention to the tips of the fingers, the thumbs and the areas between the fingers) until the solution has evaporated and the hands are dry.

7. Community Considerations  This policy acknowledges that some facilities outside Healthcare premises present particular challenges for effective hand decontamination practice.  The use of an alcohol-based gel must be considered whenever and washing facilities are problematic.

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8. Look After Your Hands  An emollient hand cream must be used regularly, e.g. after washing hands before a break or going off duty, and when off duty to maintain the integrity of the skin.  Hand creams should be dispensed via non-refillable pump dispensers or individual tubes.

9. Further Information  Leaflets about hand hygiene for both staff and patient/clients are included at the end of this policy and should be copied and distributed by all teams/departments on a regular basis.

10. Supporting Literature 10.1 Boyce, J.M. Pittet. D. 2002. Guidelines for Hand Hygiene in Healthcare Settings: Recommendations of the Healthcare Infection Control Practices Advisory Committee and the HIPAC/SHEA/APUC/IDSA Hand Hygiene Task Force. Infection Control & Hospital Epidemiology. 23 S3-40 Hoffman, P.N. et al 1985. Micro organisms isolated from skin under wedding rings worn by medical staff. BMJ.290:206-207. Infection Control Nurses Association.2002. Hand Decontamination Guidelines. ICNA. London. Pratt, R. J. Pellowe, C. M. Wilson, J. A. Loveday, H.P. Harper, P. J. Jones, S. R. McDougall, C. Wilcox, M. 2007. Epic 2- National evidence based guidelines for preventing healthcare associated infections in NHS hospitals in England. Journal of Hospital Infection 65 S1-64.

Extensive literature on the role of hand hygiene in reducing and preventing healthcare associated infection is available from the Community Infection Control Team.

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Use of Protective Clothing Community Infection Control Policy No: 3 Planned Review: November 2009

1. Introduction 1.1 The selection, wearing and correct disposal of appropriate protective clothing (coupled with good hand hygiene) has been shown to significantly reduce the risk of occupational exposure to infectious agents and reduce the opportunity for infection transmission to both staff and patients/clients.

1.2 Appropriate protective clothing must be available in all areas where staff is giving direct patient/client care and are likely to come into contact with blood and/or body fluids.

1.3 Protective clothing can also be referred to as personal protective equipment (PPE).

1.4 For the purposes of this policy the protective clothing described is that which is most likely to be used in general primary care settings. The protective clothing described is:  Gloves  Aprons  Eye Protection  Masks  Footwear

1.5 Staff should contact the Community Infection Control Team (see Local Contacts, page 5) for advice applicable to specific situations.

2. Responsibilities 2.1 All staff  Have a responsibility to wear protective clothing appropriately.  Are required to undertake training on all aspects of the use of protective clothing.  Have a responsibility to report and replenish low levels of gloves and aprons.  To conduct risk assessment so as to ensure that protective clothing appropriate to the care/task to be undertaken is worn.

2.2 Managers  Have a responsibility to ensure that local risk assessments are carried out where appropriate so as to identify the appropriate protective clothing needed for care/activity.  To provide appropriate protective clothing, both quantity and type in all areas where patient/client contact takes place. This includes the homes of patients/clients.

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 To review, in collaboration with the Community Infection Control Team, any incidents involving inappropriate use of protective clothing, and to initiate changes to ensure that such breaches in policy do not recur.

3. General Good Practice 3.1 Protective clothing must be located in all areas where patient/client contact takes place.

3.2 Gloved hands must not be washed. Gloves must be removed, hands washed and a clean unused pair of gloves donned if necessary.

3.3 Alcohol hand rub/gel solutions must not be applied to gloved hands. Gloves must be removed, hands washed and a clean unused pair of gloves donned if necessary.

3.4 The use of gloves does not negate the need for good hand hygiene (see Community Infection Control Policy No.2: Hand Hygiene, page 9).

3.5 Stocks of protective clothing must be stored off the floor in a clean, dry storage area so as to ensure that they do not become contaminated prior to use.

3.6 Gloves and plastic aprons are single use items

3.7 Adverse reactions thought to be related to the use of protective clothing e.g. latex sensitisation/allergy must be reported to the Occupational Health Department (see Local Contacts, page 5)

3.8 Eye protection: For e.g. goggles must be available and worn when there is a risk of blood or body fluids. Eye protection is reusable and must be washed with general purpose detergent and stored dry after each use.

4. Gloves 4.1 Gloves are intended to serve two main purposes:  To protect hands from contamination with organic matter and micro organisms; and  To reduce the risks of transmission of micro-organisms to patients/clients and staff

4.2 Choosing the correct glove 4.2.1 Gloves that are acceptable to staff and CE marked must be available in all areas where patient/client contact takes place.

4.2.2 Gloves must be appropriate for use and well fitting to avoid interference with dexterity, friction, excessive sweating and/or muscle fatigue of the hands/fingers. 4.2.3 Expiry date/lifespan of gloves must be checked and adhered to.

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4.2.4 Alternatives to natural rubber latex gloves must be available. Nitrile (acrylonitrile), Polychloroprene (neoprene) and Vinyl (polyvinyl chloride – PVC), (synthetic co-polymer) gloves are suitable alternatives.  Nitrile (acrylonitrile): These gloves provide an excellent barrier against bloodborne viruses and are resistant to punctures and tears. Nitrile gloves are a good alternative for latex sensitive individuals. However, they are less elastic than NRL gloves.  Polychloroprene (neoprene): These gloves are effective against viral penetration and resist permeability from chemicals. They are suitable for NRL sensitive individuals  Vinyl (polyvinyl chloride – PVC), (synthetic co-polymer): They are only suitable for use in areas where there is a low biohazard risk as these gloves show increased permeability to bloodborne viruses and are prone to leaking. Vinyl gloves are inelastic and can be ‘baggy’ to wear.

4.2.5 The use of powdered and/or polythene gloves is not acceptable during healthcare activities as they have heat sealed seams, which predisposes them to splitting

4.2.6 Using Gloves NB the activities listed under ‘appropriate use’ are not exhaustive and practitioners should undertake a risk assessment prior to all care interventions/tasks

Glove Type Appropriate Use Powder - free Latex Worn when potential exposure to blood/body fluids is likely e.g. (non-sterile) Gloves Venepuncture / cannulation Blood glucose monitoring Vaginal examination Non- surgical dentistry/podiatry Specimen collection Handling cytotoxic material Handling disinfectants Latex free Gloves (non- For use by staff identified as having latex sensitisation/latex allergy. sterile) e.g. Nitrile For use by staff caring for patients/clients identified as having latex sensitisation/allergy. See above for when these should be worn. Non-Sterile Vinyl gloves For use in healthcare interventions/tasks where contact with blood/body fluids is not anticipated. Vinyl gloves do not allow good manual dexterity, so should not be worn for tasks which require precision. Polythene Gloves To be used in Catering departments only for the preparation and handling of food. Sterile Examination Insertion of urinary catheters Gloves Clinical care to surgical wounds/drain sites Vaginal examination I obstetrics Handling central venous catheters Oro-pharyngeal or tracheal suction Sterile Surgical Gloves All surgical and/or invasive radiological procedures Household Rubber For domestic use. Gloves Cleaning of equipment not visibly contaminated with blood/body fluids.

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4.3 Changing Gloves

4.3.1 Gloves must be changed between patients/clients

4.3.2 Gloves must be changed between caring for different care/treatment activities for the same patient.

4.3.3 Both non-latex and latex gloves should be changed after two to three hours of use because the barrier of either type of glove becomes compromised with extended use.

4.3.4 Gloves are not a substitute for good hand hygiene, and this must be carried out each time gloves are removed. (See Community Infection Control Policy No.2: Hand Hygiene, page 9)

4.4 Removing and Disposing Gloves 4.4.1 Remove gloves promptly after use and wash your hands.

4.4.2 Remove gloves before touching clean areas, environmental surfaces or other persons (including yourself).

4.4.3 Remove gloves before handling or writing on charts, using telephones or computer keyboards.

4.4.4 Gloves must be removed with care so as to avoid contamination. The wrist end of the glove must be handled and the glove pulled down over the hand, turning the outer contaminated surface inward whilst doing so (this means that the gloves are disposed of inside out).

4.4.5 Gloves must be disposed of in the yellow stream infectious waste bags. (See Community Infection Control Policy No.8: Management of Waste, page 48) 4.5 Storing Gloves 4.5.1 Supplies of gloves waiting to be used must be stored in a clean dry area above floor level.

4.5.2 Gloves must not be decanted from their original box/packaging so as to ensure that the expiry date is accessible and product integrity maintained.

5. Aprons 5.1 Disposable plastic aprons must be worn whenever direct contact with patient/client or equipment is anticipated and when there is a risk of contamination with blood, body fluids, secretions or excretions, with the exception of sweat.

5.2 Using aprons

5.2.1 Disposable single use plastic aprons must be available in all areas where patient/client contact takes place.

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5.2.2 Single use aprons must not be reused.

5.2.3 Full body fluid repellent gowns must be worn when there is a risk of extensive splashing of blood/body fluids, secretions, excretions with the exception of sweat e.g. assisting with childbirth.

5.3 Changing Aprons 5.3.1 Aprons must be changed between patients/clients.

5.3.2 Aprons must be changed between ‘clean’ and ‘dirty’ interventions with the same patient/client so as to avoid cross- contamination.

5.3.3 Aprons must be changed between tasks (some areas may wish to adopt a colour coding system e.g. one colour disposable apron is worn for clinical/care procedures whilst another is worn for assisting patient/clients with meals/drinks).

5.3.4 Aprons must be removed immediately after use. The outer contaminated side of the apron should be turned inward, rolled into a ball and then discarded.

5.3.5 Aprons must be removed before going to clean areas, such as using the telephone and/or computer keyboards.

5.3.6 Aprons must be disposed of in the yellow stream infectious waste bags. (Community Infection Control Policy No.8: Management of Waste, page 48)

5.3.7 Hand hygiene must be carried out immediately after apron removal. (See Community Infection Control Policy No.2: Hand Hygiene, page 9)

5.4 Storage

5.4.1 Supplies of aprons waiting to be used must be stored in a clean dry area, above floor level.

5. Eye Protection 6.1 Eye protection must be worn when there is a risk of blood, body fluids, secretions or excretions splashing into the eyes e.g. during dental, obstetric and podiatry procedures.

6.2 Using Eye Protection 6.2.1 Eye protection must be available in all areas where patient/client contact takes place.

6.2.2 Eye protection – either goggles or glasses - must be well fitting and comfortable to wear.

6.2.3 Eye protection must provide protection to the side areas of the eye i.e. ‘wrap around’ the eye area. Community Infection Control Policy 2008

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6.2.4 Hand hygiene must be carried out immediately after removal of eye protection. (See Community Infection Control Policy No.2: Hand Hygiene, page 9)

6.3. Eye protection must be washed after each use with hot water and general purpose detergent, rinsed and stored dry in a clean area.

6. Masks 7.1 Face masks must be worn when there is a risk of blood, body fluids, secretions or excretions splashing into the face/oral mucosa.

7.2 Using Masks 7.2.1 Face visors may be considered in place of masks and eye protection during procedures where there is a high risk of splattering or aerosolisation of blood or other body fluids.

7.2.2 HEPA (high efficiency particulate air) filtering masks must be worn by healthcare professionals when direct exposure to respiratory secretions and infectious TB patients/clients is unavoidable e.g. cough inducing procedures such as inhalation of pentamidine, or sputum induction. Please contact the Community Infection Control Team for further information.

7.2.3 Dentists and their assistants routinely wear disposable surgical masks during patient/client treatment to protect the face/oral mucosa from aerosols and/or splashing of blood/body fluids.

7.2.4 Masks must be changed between patients/clients/procedures.

7.2.5 Disposable surgical masks must be changed if they become wet or soiled so as to ensure continued protection to the wearer.

7.2.6 Masks should be disposed of in the yellow stream infectious waste bags. (See Community Infection Control Policy No.8: Management of Waste, page 48)

7.2.7 Hand hygiene must be carried out immediately after apron removal. (See Community Infection Control Policy No: 2: Hand Hygiene, page 9)

7.3. Supplies of masks waiting to be used must be stored in a clean dry area, above floor level.

7.3.1 Face masks with expiry dates must not be decanted from their original box/packaging so as to ensure that the expiry date is accessible and product integrity maintained.

7. Footwear 8.1 Staff providing patient/client care must wear closed toed shoes to avoid contamination with blood or other body fluids and /or potential injury from sharps.

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8.2 Open footwear must not be worn in areas where blood or body fluids could be spilt or where sharps are handled.

8.3 Foot wear should be kept clean.

8.4 Overshoes must not be worn. These can lead to unnecessary hand contamination while donning/removing and can cause aerosolisation of micro organisms due to bellowing when walking.

8.5Hand hygiene must be carried out immediately after handling of any footwear. (See Community Infection Control Policy No.2: Hand Hygiene, page 9)

8. Uniforms and White Coats 9.1 Uniforms and/or white coats are not protective clothing.

9.2 Disposable plastic aprons must be worn over uniforms/white coats as described in section 5 above.

9.3Uniforms and/or white coats must be changed daily in normal use, or immediately if contaminated.

9.4 Uniforms must not be worn to travel to and from work. 9.5 Uniforms must be laundered at a temperature of 65°c or at the highest temperature the item will withstand. Uniforms and/or white coats must be laundered separately from other items

9. Personal Clothing 10.1 Disposable plastic aprons must be worn over personal clothing as described in section 5 above.

10.2 Personal clothing worn whilst on duty must be changed daily and washed at the highest temperature that the item will withstand.

10.3 Personal clothing must be of a design that allows sleeves to be rolled up to above elbow level during the delivery of healthcare and whilst performing hand hygiene.

10. Supporting Literature Ayliffe GAJ; Fraise AP; Geddes AM; Mitchell K. 2000. Control of Hospital Infection. A Practical Handbook. 4th edition. Health & Safety Executive. 2002. The Personal Protective Equipment at Work Regulations. HSE GirouE; Chai SH; Oppein F; Legrand P; Ducellier D; Cizeau F; Brun-Buisson C. 2004. Misuse of gloves: the foundation for poor compliance with hand hygiene and potential for microbial transmission? Journal of Hospital Infection. 57.162-9. June. Infection Control Nurses Association. 2002. Protective Clothing: principles and Guidance. ICNA. Loh W; Ng VV; Holton J. 2000. Bacterial flora on the white coats of medical students. Journal of Hospital Infection. 45(1) 65-68.

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Medical Devices Agency.1996. MDA DB(96)01. Latex sensitisation in the healthcare setting: use of latex gloves. NHS Plus, Royal College of Physicians, Faculty of Occupational Medicine (2008). Latex Allergy: Occupational Aspects of Management. A National Guideline. London: RCP. Perry C; Marshall R; Jones E. 2001. Bacterial contamination of uniforms. Journal of Hospital Infection. 48(3) 238-241 Pratt RJ; Pellowe CM; Wilson JA; Loveday HP; Harper PJ; Jones SR; McDougall C; Wilcox M; 2007. epic 2 – National evidence based guidelines for preventing healthcare associated infections in NHS Hospitals in England. Journal of Hospital Infection. 65 S1-64

Roberts JM. 1994. Handwashing and protective clothing in community healthcare services. in MA Worsley (Ed) Infection control – a community perspective. Turner P. 1997. Latex glove allergy. Occupational Health. Vol:49. February.

Extensive literature regarding the role of protective clothing in the prevention and reduction of healthcare associated infection is available from the Community Infection Control Team.

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Occupational Health and the Control of Infection Community Infection Control Policy No: 4 Planned Review: November 2009

1. Introduction The broad aim of the Occupational Health Service is to minimise work- related ill health and prevent healthcare workers becoming ill as a result of their job.

1. Occupational Health and the Control of Infection 2.1 The Occupational Health Service contributes to the control of infection by working in collaboration with staff, managers and the Infection Control Team, for example:  The administration of hepatitis B vaccine, followed by a titre check to establish immune status*  Provision of support and guidance to health care workers who are hepatitis B e antigen positive.  Support and guidance in the modification of work practices to those managing healthcare workers found to be hepatitis B e antigen positive**  Support and guidance to healthcare workers infected with blood borne viruses such as hepatitis B, C or HIV.  Support and guidance in the modification of work practices to those managing healthcare workers known to be infected with blood borne viruses such as hepatitis B, hepatitis C or HIV.***  Advice and guidance to any staff member experiencing irritation to hands thought to be associated with use of hand washing solutions (liquid soap and/or alcohol based products).  Advice and guidance to any staff member reporting/suspecting latex sensitisation.  Advice and guidance on exclusion of staff known/suspected to have an infectious illness.  Advice to staff post exposure to an infectious disease

*Managers must satisfy themselves of the immunisation status of all staff, including agency and locum staff. **Healthcare workers who are hepatitis B e antigen positive must not perform exposure prone procedures. ***An exposure prone procedure is: Exposure prone procedures (EPPs) are those where there is a risk that injury to the worker may result in exposure of the patient’s open tissues to the blood of the worker. These procedures include those where the workers gloved hands may be in contact with sharp instruments, needle tips or sharp tissues (spicules of bone or teeth) inside a patient’s open body cavity, wound or confined anatomical space where the hands or fingertips may not be completely visible at all times. From: HIV Infected Health Care Workers: Guidance on Management and Patient notification. Department of Health, July 2005.

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***Healthcare workers infected with blood borne viruses must not participate in exposure prone procedures until expert advice has been sought.

3. Occupational Health Services 3.1 Staff must use the Occupational Health Service provided by their employer (see Local Contacts, Page 5).

3.2 Those staff working in General Medical Practice must access the Occupational Health Advice within their Trust.

3.3 Staff working in General Dental Practice must access the Occupational Health Advice within their Trust.

4. Supporting Literature Advisory Committee on Dangerous Pathogens. 1995. Protection against blood borne infections in the workplace. HIV and Hepatitis. PL.CO(90)5. Department of Health 2006. The Health Act 2006. Code of practice for the prevention and control of healthcare associated infections. London. Department of Health.2005. HIV Infected healthcare workers: guidance on management and patient notification. London. Department of Health 2000. Hepatitis B infected healthcare workers. London.

Further literature on the relationship between occupational health and the control of infection is available from the Community Infection Control team.

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The Prevention of Sharps Injury Community Infection Control Policy No: 5 Planned Review: November 2009

1. Responsibilities 1.1 Staff  Have a responsibility to manage the safe handling and disposal of sharps in all care settings.  Have a responsibility to undertake training in the safe handling and disposal of sharps.  Have a responsibility to ensure that self medicating patients/clients have been educated about the safe disposal of sharps (see Community Infection Control Policy No 8: Management of Waste, Page no. 48)  Have a responsibility to report difficulties in the implementation of this policy to the line manager and/or via the incident reporting system of each organisation.

1.2 Managers  Have a responsibility to ensure that local risk assessments are carried out to identify the appropriate use of protective clothing, and adherence to the best practice outline in this policy document.  Have a responsibility to ensure that staff can access the available training on safe handling and disposal of sharps.  Have a responsibility to ensure that staff are resourced to provide specific training to self medicating patients/clients on the safe handling and disposal of sharps.  Have a responsibility to immediately address any reported difficulties in the implantation of this policy.

2. Good Practice 2.1 Before Use  Ensure that the sharps box is correctly assembled.  Ensure that the label on the box is completed upon assembly.  Sharps boxes must comply with UN and BS standards.  Boxes must be available in sizes appropriate for the disposal of sharps in the care setting in which they are to be used.  Appropriately colour coded sharps boxes must be available. (See Community Infection Control Policy No.8: Management of Waste, page 48)  Sharps boxes must be stored/positioned safely for use and as close to the point of use as possible, e.g. within a tray device  With room for an integral sharps container or, wall mounted below shoulder height.  Sharps boxes must never be placed on the floor.  Safer needle devices must be used as appropriate.

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 Single use retractable lancets must be used for all capillary blood sampling.

2.2 During Use  Practitioners must be competent in procedures using sharps.  Cuts and abrasions must be covered with a waterproof dressing before providing care. Staff with skin conditions must seek advice from Occupational Health in order to minimise risk of infection via open skin lesions.  Gloves must be worn when handling sharps. (See Community Infection Control Policy No.3: Use of Protective Clothing, page 15)  Other protective clothing must be worn as necessary to avoid exposure e.g. aprons, eye protection. (See Community Infection Control Policy No.3: Use of Protective Clothing, page15)  Open footwear must not be worn in areas where sharps are handled.  Assemble devices with care.  Needles and syringes must be disposed of as one single unit.  Do not resheath used needles with needle covers. The exception to this is local anaesthetic syringes in dental practice – these must be resheathed using a commercial safety device or a safe technique.  Single use disposable blade devices should be used in community care settings.  Extra vigilance is needed during emergency procedures.

2.3 After Use  Disposal of sharps is the responsibility of the user.  Used needles must be disposed of immediately after use.  Fill sharps boxes only to the ‘fill’ line and never overfill.  Shut and lock box when full.  Label box with source e.g. clinic/practice name or code.  Attach identity or coded tag.  Remove full sealed sharps boxes to the designated disposal area as soon as they have been sealed.  Do not use tape to seal sharps boxes.  Never place sharps boxes in bags prior to disposal.  Damaged sharps boxes must be placed into a larger sharps box for disposal.  Practitioners visiting patients/clients at home must carry community size sharps bins (see below for recommended product). (See Community Infection Control Policy No.9: Management of Waste, page 54)  Patients who receive regular injections either from a health care professional or self administered must be provided with a sharps box, and collection arranged through the Local Authority Waste Collection Service - See Local Contacts, page no 5.

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2.4 Current recommended products are:  Rexam Sharpax Sharps bins (use in Static areas)  Frontier Medical Sharpsafe 0.6L ( to be carried by practitioners using sharps in patients/clients’ own homes)

3 Supporting Literature Department of Health. 2002. Getting Ahead of the Curve. A Strategy for combating infectious diseases (and other aspects of health protection). Department of Health. Health Protection Scotland. 2008.Literature review: occupational exposure management, including sharps injuries. www.hps.scot.nhs.uk. Infection Control Nurses Association. 2005. Audit tools for monitoring infection control standards in Primary and Community Care. ICNA. National Institute for Clinical Excellence. 2003. Infection Control: prevention of healthcare associated infection in Primary and Community care. NICE. Pratt RJ; Pellowe CM; Wilson JA, Loveday HP; Harper PJ; Jones SR; McDougall C; Wilcox M. 2007 epic-2. National evidence based guidelines for preventing healthcare associated infection in NHS Hospitals in England. Journal of Hospital Infection. 65 S1-64

Extensive literature on the prevention of sharps injuries is available from the Community Infection Control Team.

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The Management of Sharps, Needlestick and Splashing Incidents Community Infection Control Policy No: 6 Planned Review November 2009

1. Definition 1.1 These are incidents involving contamination with blood/body fluids except urine or faeces unless they are visibly blood stained.

1.2 Needlestick injury, puncture wound, cut or bite (even if gloves or other protective clothing were being worn) should be reported as an incident, following the incident reporting policy of each organisation.

3.2 Contamination of an already established cut or abrasion with blood or body fluids or splashing to the mouth/eye must be reported as an incident.

2. Roles and Responsibilities 2.1 You are responsible for:  Performing immediate first aid. See – ‘Action to be taken in the event of a Sharps, Needlestick or Splashing Injury’.  Reporting the incident as per local procedures immediately. See- ‘Action to be taken in the event of a Sharps, Needlestick or Splashing Injury’.  Immediate reporting is required as post exposure prophylaxis may be most beneficial if started within 2 hours of the incident taking place.

2.2 Managers/Supervisors have the responsibility to ensure that the incident is managed effectively:  Ensure that first aid is carried out effectively.  Ensure that the source of the injury is managed and information gathered, see Section 3 of this policy Occupational Health at point 3.  Ensure that appropriate support is available following an exposure incident e.g. referral to Occupational Health and subsequent follow-up as necessary.  Ensuring that the incident is reported correctly.  Addressing the cause of the incident in order that similar incidents can be avoided if possible in the future.  Ensuring that training is undertaken by all staff so as to ensure that they know how to manage this type of incident.

3. Occupational Health 3.1 Following an incident of this type Occupational Health will require the following information: 3.1.1 About the injury:  Type of exposure /injury  Colour and type of needle/sharp Community Infection Control Policy 2008

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 Procedure being undertaken at the time of injury  Time injury occurred

3.1.2 About the injured person (recipient):  Has the recipient had Hepatitis B vaccine  If yes, what were last antibody levels?

3.1.3 About the Source of the Injury (Donor) The senior clinician caring for the patient must be asked to obtain this information. If the senior clinician has sustained the injury another senior clinician must be asked to gather this information.  Name  Age  Diagnosis  Does the patient have a known bloodborne infection e.g. hepatitis B, hepatitis C, HIV.  Is the patient an IV drug user?

3.2 The guidance contained within this policy only pertains to the immediate action needed following this type of injury. Explanatory notes on post- exposure prophylaxis, testing of source and recipient, counselling and so on are available from the Occupational Health Departments of each organisation and must be available for staff information in each department/team.

3.3 The next section contains immediate action to be taken and contact numbers for: City & Hackney Primary Care Trust – GREEN General Practitioners – RED General Dental Practitioners – BLUE Copies of the full policy detailing Post exposure Prophylaxis can be obtained from your manager or Occupational Health Department.

4. Supporting Literature Department of Health. 2005. HIV infected healthcare workers: guidance on management and patient notification. Department of Health. Department of Health. 2004. HIV Post - exposure Prophylaxis. Guidance from the Chief Medical Officer’s Expert Advisory Group on AIDS. 2nd Edition. London. Department of Health. 2000. Hepatitis B infected healthcare workers. Department of Health. London. Advisory Committee on Dangerous Pathogens. 1995. Protection against blood borne infections in the workplace. HIV and hepatitis. PL CO (95)5.

Extensive literature on healthcare workers, sharps, needlestick and splashing incidents and implications for the control of infection is available from the Community Infection Control Team.

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City & Hackney Primary Care Trust Management of Sharps, Needlestick and Splashing Injuries Contact Details/Steps to follow

These are incidents involving contamination with blood or body fluid, except urine or faeces unless they are visibly blood stained.

Action to be taken by an injured member of staff following an incident.

FIRST AID & IMMEDIATE HELP 1. Encourage bleeding where skin is punctured. Do not suck the area. 2. Wash thoroughly with soap under running warm water. Do not scrub. 3. If eyes are involved, wash immediately with water for 5-10 minutes (use sterile water if available, otherwise tap water). If the mouth is contaminated rinse with plenty of water. 4. Where gross contamination of unbroken skin has occurred remove contaminated clothing and wash all affected areas with copious amounts of soap and water. 5. Inform your manager or immediate senior about the incident promptly. 6. Contact Occupational Health IMMEDIATELY

During working hours: 08.30 – 16.30 Monday – Friday

Needlestick Injury Hotline: 020 7601 7825

Out of working Hours: 16.30 – 08.30 including Weekends and Bank Holidays

Attend Accident & Emergency at Homerton Hospital and contact Senior Registrar – Virology or the Virologist on Call on 020 7601 7356 via switchboard at Royal London NHS Trust who will be able to advise you.

Do not delay reporting this type of injury. Prophylactic treatment - if indicated - is most effective if started within 2 hours of the injury.

Copies of the full policy detailing ‘Post exposure Prophylaxis’ can be obtained from your manager or Occupational Health Department.

7. Complete an Incident Form

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Employees of General Medical Practitioners Management of Sharps, Needlestick and Splashing Injuries Contact Details/Steps to follow

These are incidents involving contamination with blood or body fluid, except urine or faeces unless they are visibly blood stained.

Action to be taken by an injured member of staff following an incident.

FIRST AID & IMMEDIATE HELP 1. Encourage bleeding where skin is punctured. Do not suck the area. 2. Wash thoroughly with soap under running warm water. Do not scrub. 3. If eyes are involved, wash immediately with water for 5-10 minutes (use sterile water if available, otherwise tap water). If the mouth is contaminated rinse with plenty of water. 4. Where gross contamination of unbroken skin has occurred remove contaminated clothing and wash all affected areas with copious amounts of soap and water. 5. Seek IMMEDIATE advice from Occupational Health. 6. Inform your manager or immediate senior about the incident promptly. 7. Contact Occupational Health 8. Complete an Incident Form

During working hours: 0830 – 1630 Monday – Friday

Needlestick Injury Hotline: 020 7601 7825

Out of working Hours: 1630 – 0830 including Weekends and Bank Holidays

Attend Accident & Emergency at Homerton Hospital and contact Senior Registrar – Virology or the Virologist on Call on 020 7601 7356 via switchboard at Royal London NHS Trust who will be able to advise you.

Do not delay reporting this type of injury. Prophylactic treatment - if indicated - is most effective if started within 2 hours of the injury.

Copies of the full policy detailing Post exposure Prophylaxis can be obtained from your manager or Occupational Health Department.

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Employees of General Dental Practice Management of Sharps, Needlestick and Splashing Injuries Contact Details/Steps to Follow

These are incidents involving contamination with blood or body fluid, except urine or faeces unless they are visibly blood stained.

Action to be taken by an injured member of staff following an incident.

FIRST AID & IMMEDIATE HELP 1. Encourage bleeding where skin is punctured. Do not suck the area. 2. Wash thoroughly with soap under running warm water. Do not scrub. 3. If eyes are involved, wash immediately with water for 5-10 minutes (use sterile water if available, otherwise tap water). If the mouth is contaminated rinse with plenty of water. 4. Where gross contamination of unbroken skin has occurred remove contaminated clothing and wash all affected areas with copious amounts of soap and water. 5. Seek IMMEDIATE advice from Occupational Health 6. Inform your manager or immediate senior about the incident promptly. 7. Contact Mark Hopwood or Taffy Musungwa at Occupational Health 8. Complete an Incident Form

During working hours: 0830 – 1630 (Monday – Friday)

Needlestick Injury Hotline: 020 7601 7825

Out of working Hours (1630 – 0830) including Weekends and Bank Holidays

Attend Accident & Emergency at Homerton Hospital and contact Senior Registrar – Virology or the Virologist on Call on 020 7601 7356 via switchboard at Royal London NHS Trust who will be able to advise you.

Do not delay reporting this type of injury. Prophylactic treatment - if indicated - is most effective if started within 2 hours of the injury.

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Management of Healthcare Equipment Community Infection Control Policy No: 7 Planned Review November 2009

1. Introduction 1.1 Health and social care settings contain a diverse population of micro organisms. Inevitably healthcare equipment will become contaminated during care delivery and will need to be decontaminated after use so as to reduce the risk of contamination/infection of staff, patients/clients and/or visitors during subsequent use.

1.2 Appropriate decontamination of healthcare equipment is essential to reducing their potential contribution to healthcare associated infection.

1.3 The principles outlined in this policy are a guide to best practice. Practitioners are urged to seek further advice from the Community Infection Control Team about the decontamination of specific equipment and/or for equipment used on patients/clients with known infections or resistant micro organisms.

1.4 The A - Z decontamination list provides advice on the decontamination of commonly used healthcare equipment but is not exhaustive and practitioners should seek further advice from the Community Infection Control Team as necessary.

1.5 Guidance on the use of bench top sterilisers can be found at Appendix 9 of this policy.

2. Single Use and Single Patient/Client Use Devices 2.1 Single Use Medical Devices  Single use devices are easily recognisable by the symbol below on the packaging (or device itself).

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 These devices must only be used once and then discarded immediately in the appropriate waste stream. The reuse of a single use item exposes both patients/clients and staff to unacceptable risks. These risks outweigh any perceived benefit of reusing such devices. Do not reuse single use items.

2.2Single Patient/Client Use Medical Devices  Single patient/client use devices are clearly marked as such on the packaging.  Single patient/client use items can be used on the same patient/client according to the manufacturer’s guidance.

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 Single patient/client use items must be cleaned and stored between uses in such a way as to ensure that they are reused on the same patient/client only.  Manufacturer’s guidance on cleaning between uses must be followed. Contact the Community Infection Control Team (see Local Contacts, page 5) for further guidance as necessary.

3. Roles and Responsibilities 3.1 All Staff:  Have a responsibility to ensure that medical devices used in the areas in which they work are used appropriately.  Have a responsibility to ensure that single use items are not reused.  Have a responsibility to ensure that single patient/client use items must be cleaned and stored between uses in such a way as to ensure that they are reused on the same patient/client only.  Have a responsibility to ensure that any reusable devices are cleaned and stored appropriately after each use.  Have a responsibility to apply the principles of hand hygiene (see Community Infection Control Policy No.2: Hand Hygiene, page 9).  Have a responsibility to use appropriate protective clothing when involved in the decontamination of equipment (see Community Infection control Policy No.3: Use of Protective Clothing, page 15).  Have a responsibility to seek advice from the Community Infection Control Team as necessary.

3.2 Managers  Have a responsibility to ensure that sufficient resources are available so as to ensure that single use devices are not reused.  Have a responsibility to ensure that staff involved in the decontamination of equipment are applying the principles of best practice outlined in this policy and according to specific manufacturer’s instructions.  Have a responsibility to ensure that staff have access to sufficient resources to allow them to decontaminate reusable devices in accordance with the best practice outlined in this policy.  Have a responsibility to ensure that the decontamination of healthcare equipment is considered prior to purchase. See Section 4 of this policy Purchase of Healthcare Equipment.  Have a responsibility to ensure that staff have access to appropriate protective clothing (see Community Infection Control Policy No.3: Use of Protective Clothing, page 15)  Have a responsibility to ensure that staff have access to appropriate hand hygiene facilities (see Community Infection Control Policy No:2: Hand Hygiene, page 9).

4. Purchase of Healthcare Equipment 4.1 The purchase of reusable healthcare equipment must be discussed with the Community Infection Control Team prior to purchase so as to ensure that the manufacturer’s guidance for decontamination is compatible with local decontamination processes and policies. Community Infection Control Policy 2008

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5. Storage of Healthcare Equipment  Used healthcare equipment must be stored in a designated area, away from equipment that has already been decontaminated.  Healthcare equipment must be stored clean and dry.  Check all healthcare equipment for visible contamination prior to use.  Healthcare equipment must not be stored on the floor, but on rack type shelving or cabinets.  Storage areas must be clean and tidy and included in the regular cleaning schedule for the department /premises.

6. Decontamination 6.1 Decontamination is a process which removes or destroys contaminants so that infectious agents or other contaminants cannot reach a susceptible site in sufficient quantities to initiate infection or any other harmful response. Differing levels of decontamination are used depending on the device and the procedure it has been used for. The levels are:  Cleaning.  Cleaning followed by disinfection.  Cleaning followed by sterilisation.

6.2 Disinfection is a process used to reduce the number of viable infectious agents but which may not necessarily inactivate some microbial agents such as bacterial spores. Disinfection does not achieve the same reduction in microbial contamination as sterilisation.

6.3 Sterilisation is a process used to render an object free from viable micro organisms including viruses and spores (but may not include prions).

6.4 The level of decontamination required for an item is dependent upon the anticipated use of that item. The MHRA provides the following guidance:

Level of risk Use of Item Decontamination Process Low risk  In contact with intact skin  Not in contact with patient/client Cleaning  In contact with broken skin Medium Risk  In contact with mucous Cleaning membranes  Used on immunocompromised Followed by patients/clients  In contact with pathogenic Disinfection or organism that is readily Sterilisation transmissible High Risk  In contact with broken mucous Cleaning membranes Followed by  Entering sterile body cavity Sterilisation

7. Decontamination of Equipment, A – Z 7.1 Healthcare device must be decontaminated away from treatment/clinical areas and in areas that are not accessible by the public. Community Infection Control Policy 2008

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7.2 Healthcare equipment marked as single use must not be decontaminated and must be disposed of immediately after use.

7.3 Single patient/client use items must be cleaned and stored between uses in such away as to ensure that they are reused on the same patient/client only.

7.4 Appropriate protective clothing must be worn during the decontamination of healthcare equipment.

7.5 Hand hygiene must be carried out after removal of protective clothing (see Community Infection Control Policy No.2: Hand Hygiene, page 9).

7.6 Disinfectant solutions must be accurately made up immediately prior to use and discarded once used.

7.7 Electrical equipment must be disconnected from the electrical supply before decontamination takes place.

7.8 The A - Z decontamination list provides advice on the decontamination of commonly used healthcare equipment but is not exhaustive and practitioners must seek further advice from the Community Infection Control Team as necessary

Equipment Cleaning agent Comments Airways Single Use Dispose of as healthcare waste Disposable immediately after use.

Ambubag Single use Dispose of as healthcare waste immediately after use.

Auroscope Speculae Single Use Disposable tips must be used. Dispose Disposable of as healthcare waste immediately after use. Baby changing mats General Purpose Cover with disposable towel. Change Detergent (GPD) towel between babies. Mats must be washed with GPD and warm water at the end of each session, using a disposable cloth. If visibly soiled treat as a spillage (see Management of Spillages, page 54). Inspect regularly. If plastic covering is torn or damaged the mat must be removed from use and disposed of. Baby weighing scales General Purpose Cover with disposable towel. Change Detergent (GPD) between each baby. Clean with GPD and hot water at the end of each session. Use a disposable cloth. If visibly soiled treat as a spillage. (See Management of Spillages, page 54). .

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Decontamination of Healthcare Equipment

Equipment Cleaning agent Comments Bed cradles In patient/client’s home General Purpose Wash with GPD and hot water prior to Detergent (GPD) return to community equipment stores. If visibly soiled treat as a spillage. (See Management of Spillages, page 54).

Wash with GPD and hot water. If visibly On return from General Purpose soiled treat as a spillage. (See patient/client Detergent (GPD) Management of Spillages, page 54). Check for signs of wear and tear and remove from use if cracked or damaged. Store clean and dry. Bed frames In patient/client’s home General Purpose Wash prior to return to community Detergent (GPD) equipment stores. If visibly soiled treat as a spillage. (See Management of Spillages, page 54).

On return from General Purpose Wash with GPD and hot water. If visibly patient/client Detergent (GPD) soiled treat as a spillage. (See Management of Spillages, page 54). Bed pans, urinals and commode pans. In patient/client’s home Hypochlorite Empty contents down toilet. Avoid splashing. Rinse with hot water to remove visible contamination. Wash with hypochlorite solution (1000ppm) and disposable cloth. Rinse bed pan. Avoid splashing. Dispose of cloth. Store dry.

On return from Bed pan washer If disposable bed/commode pans are patient/client used, contents must be emptied as above. Place empty container in healthcare waste sack. Arrange healthcare waste collection with Local Authority service (see Local Contacts, page 5). Place in bedpan washer for routine cycle. Store clean and dry. Inspect for wear and tear. Cracked or damaged equipment must be removed from service.

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Equipment Cleaning Agent Comments Blinds ( window) General Purpose Cleaning of roller and/or vertical blinds Detergent (GPD) must be part of the routine schedule for each area. Wipe with GPD and hot water weekly. If washable they must be laundered quarterly.

If visibly soiled treat as a spillage. (See ‘Management of Spillages’, page 54) Venetian blinds are not suitable for use in healthcare premises unless encased between 2 panes of glass. Blood Pressure Cuffs Launder Wipe with GPD and hot water at the end Single patient use of each session. Change immediately if visibly contaminated heat clean in washing machine (71°c) Single use cuffs must be used on patients/clients with non intact skin and/or lesions in the area of cuff placement. Single use cuffs must be discarded immediately after use. Bowls Disposable Dispose of immediately after use. Surgical or Return to Sterile Services provider (see Sterile Services local policies) for decontamination

Patient/client washing General Purpose Clean with GPD and hot water. Wash bowl detergent (GPD) and dry thoroughly after each use. Store clean and dry (inverted). Carpets Clinical areas Vacuum Clinical areas must not be carpeted. Avoid carpeting these areas.

Non clinical areas – Steam clean Cleaning of carpets must be part of the health care premises routine cleaning schedule of each area. Carpets must be vacuumed every day that the area is used. Carpets must be steam cleaned at least quarterly. Spillages of blood/body fluids must be dealt with initially using the principles outlined in ‘Management of Spillages’, page 66. Then arrangements for the immediate steam cleaning of carpets following a spill must be in place. Care must be taken to ensure that the

In patient/client’s home General Purpose Contractor cleans and decontaminates Detergent (GPD) any cleaning equipment (including mechanical aids) after each use. In the event of a spillage of blood or body fluids on a carpet in a patient/client home general purpose detergent must be used to clean the spill so as to avoid damaging the carpet.

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Equipment Cleaning Agent Comments Catheter drainage bags Single Use or Single Patient/ Client use Cervical caps Single Use Dispose of immediately after use. or Single Patient/ Women must be given advice on the Client Use cleaning of cervical caps at the time of dispensation. Commode frames General Purpose Wash weekly with GPD and hot water. In patient/client’s home Detergent (GPD) Dry with disposable paper towel.

Wash prior to return to community On return from General Purpose equipment stores. If visibly soiled treat patient/client’s home Detergent (GPD) as a spillage. (See Management of Spillages, page 54). Wash with GPD and hot water. Then wipe with hypochlorite 1000ppm. Use disposable cloth. If visibly soiled treat as a spillage. (See Management of Spillages, page 54). Inspect for wear and tear. Damaged equipment must not be used. Cool Boxes General Purpose Clean after each use with GPD and hot (used for transportation Detergent (GPD) water. Dry with disposable paper towel. of vaccines) If vaccine spillage has occurred treat as a spillage. (See Management of Spillages, page 54). Crockery and Cutlery Dishwasher Use dishwasher if available. General Purpose Hand wash in GPD and hot water. Air Detergent (GPD) dry or dry with disposable paper towel. Store all crockery and cutlery clean and dry. Curtains Launder These must be changed and laundered every 3 months or immediately if visibly soiled. Dishwasher Dishwashers must be part of the routine cleaning schedule for each area/department. Dishwasher must be subject to routine maintenance – Estates & Facilities will advise on the necessary frequency (see Local Contacts, page 5). Dental hand pieces Sterilise after each According to manufacturer’s guidance. use Must be decontaminated after every patient/client use. See also advice from British Dental Association. Dental mirrors (for use Single use Dispose of as healthcare waste during school immediately after use. inspection) Doppler machine Clean after each Follow manufacturer’s guidance use

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Equipment Cleaning Agent Comments Dressing trolley General Purpose Clean with GPD and hot water at the Detergent (GPD) beginning of each session and/or when visibly soiled. Use a disposable cloth. If visibly soiled with blood/body fluids clean with 10,000ppm hypochlorite solution. (See Management of Spillages, page 54). Ear Syringing See Appendix 7, Page 77 Equipment Eye protection General Purpose Wash with GPD and hot water after Detergent (GPD) each use. Store clean and dry. If visibly soiled with blood/body fluids wash with hypochlorite solution (10,000ppm). (See Management of Spillages, page 54). Examination couches General Purpose Cover with disposable paper roll. Detergent (GPD) Change after each patient. Wash with GPD and hot water at the end of each session. If visibly soiled with blood/body fluids treat as a spillage. (See Management of Spillages, page 54). Inspect couch for wear and tear. Damaged upholstery must be professionally repaired or recovered immediately. Blankets and/or non-disposable linen must not be used on examination couches. The cleaning of the supporting framework of examination couches must be part of the routine cleaning schedule for each clinical area. Fans (electrical) Electrical fans must be clean and dust free. They must be subject to routine maintenance and cleaning by Estates and Facilities, see Local Contacts, Page 5. When not in use fans must be stored covered to prevent the accumulation of dust and debris on rotating blades. Floors The cleaning of floors must be part of the routine cleaning schedule for each area. In the event of a spillage of blood/body fluids the guidance outlined in Management of Spillages, (page 66) must be followed.

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Equipment Cleaning Agent Comment Foot Stools General Purpose Cover with disposable paper towel if Detergent (GPD) used for dressing changes, podiatry procedures etc. Wash with GPD and hot water at the end of each session. Pay particular attention to horizontal surfaces and /or grooves where dust and debris may collect. If visibly contaminated with blood/body fluid treat as a spillage. (See Management of Spillages, page 54). Damaged waterproof covering must be professionally repaired or recovered immediately. Damaged foot stools must be removed from use. Hands See Community Infection Control Policy No:2, Hand Hygiene, page 9. Hoists -Frames In patient/client’s home General Purpose Wash weekly with GPD and hot water. Detergent (GPD) Dry with disposable paper towel. Wash prior to return to community equipment stores. If visibly soiled treat as a spillage. (See Management of Spillages, page 54).

In healthcare premises General Purpose Cleaning of supporting frames must be Detergent (GPD) part of the routine cleaning schedule for each area.

On return from General Purpose Wash with GPD and hot water. Then patient/client’s home Detergent (GPD) wipe with hypochlorite 1000ppm. Use disposable cloth. If visibly soiled treat as a spillage. (See Management of Spillages, page 54). Inspect for wear and tear. Damaged equipment must be removed from use. Hoists - slings Single Each patient/client must have his/her patient/client use. own sling for use with hoist. The Launder frequency of laundering will vary according to usage. If visibly soiled immediate laundering must take place. Slings must be laundered between patient/clients. Hydrotherapy Pool See specific local guidance. Contact Community Infection Control Team and Estates & Facilities for further detailed advice. See Local Contacts, page 5. Infusion, enteral feed General Purpose Wipe daily with a disposable damp cloth pumps Detergent (GPD) and GPD. Ensure surfaces are completely free from feed and/or infusate residue. Use an alcohol wipe if contaminated with blood/body fluids.

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Equipment Cleaning Agent Comments Instruments Single Use Single use instruments must be -used Sterile Services disposed of immediately after use. (See Community Infection Control Policy No. 8, Management of Waste, page 48). Reusable equipment must be returned to Sterile Services following the procedure outlined by the Sterile Services Provider. Independent contractors and Community Dental Services who do not access Sterile Services must refer to the local decontamination procedures agreed with Community Infection Control Team. (See also Appendix 9 – Use of Bench Top Steam Sterilisers, page 82). Keyboards General Purpose Keyboards in clinical areas must be - clinical areas Detergent (GPD) covered with a cover that is impermeable to fluids and that allows the keyboard to be used whilst the cover is in place. Keyboard covers must be wiped with GPD and damp cloth at the end of each session. Laryngoscopes - hand piece 70% alcohol wipe After use remove bulb and wash. Wipe over hand piece with 70% alcohol wipe. Dispose of immediately after use as - blades Single Use healthcare waste. Mattresses Specialist pressure General Purpose Wash weekly with GPD and hot water. relieving mattresses Detergent (GPD) Dry with disposable paper towel. Wash prior to return to Community - in patient/client home Equipment stores. If visibly soiled treat as a spillage. (See Community Infection Control Policy no. 9 - Management of Spillages, page 54). On return from Prior to removal from the patient/client’s patient/client’s home home mattresses must be washed with GPD and hot water. If visibly soiled treat as a spillages. See Community Infection Control Policy – Management of Spillages, page 54). Rental mattresses must be returned to the rental company for cleaning. Mattresses owned by Community Equipment Stores must be returned to the central store for cleaning prior to being loaned again. Mouthpieces Single use Dispose of as healthcare waste For use with inhalers immediately after use. Medicine pots Single use Dispose of as healthcare waste immediately after use

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Equipment Cleaning Agent Comments Nailbrushes Single use Nailbrushes must only be used in For use in operating Operating Theatres and main food theatres preparation kitchens. In both & main food preparation locations they must be disposable kitchens only single use items. Dispose of as healthcare waste immediately after use. Nebulisers Single patient/client use Nebuliser acorns, masks and tubing Masks & tubing can be reused on the same patient Single Use provided they are marked as ‘Single Patient Use’. Wash mask and acorn with GPD and hot water after each use. Dry with disposable paper towel. Store mask, pot and tubing in a designated container clearly marked with the patients name and date of birth (if not for use in patient/client’s own home). Change complete unit weekly, or immediately if soiled. If single patient/client use items can not be stored in the manner outlined above, they must be discarded immediately after use. Masks, acorns and tubing marked as single use must be disposed of immediately after use. Oxygen Masks Single Use Change daily or immediately if soiled, Dispose of as healthcare waste. Change between each patient use.

Oxygen Tubing Single Use Change daily or immediately if soiled, Dispose of as healthcare waste. Change between each patient use Pillows Disposable Cover Pillows must be covered with a waterproof covering. Whilst in use General Purpose disposable pillow cases must be Detergent (GPD) used over this waterproof covering. Wash waterproof covering with GPD and hot water at the end of each session. Store dry. Razors Single Use Dispose of immediately after use in a designated sharps bin.

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Equipment Cleaning Agent Comment Raised Toilet Seat In patient/client’s home General Purpose Wash weekly with GPD and hot Detergent (GPD) water or immediately if visibly soiled. Dry with disposable paper towel. Wash prior to return to Community Equipment stores. If visibly soiled treat as a spillage. (See Community Infection Control Policy No. 9: Management of Spillages, page 54). Prior to removal from the patient/client’s home raised toilet seats must be washed with GPD and hot water. If visibly soiled treat as a spillages. (See Community Infection Control Policy: Management of Spillages, page 54).

On return to Community Wash with GPD. Wipe with Equipment Store 1000ppm hypochlorite solution paying particular attention to grooves and fixing clips. Excessive scratching, cracks etc. will make cleaning difficult and seats like this must be discarded. Store dry. Scissors Single Use Single use scissors must be Single Patient/Client disposed of immediately after use in Sterile Services a sharps disposal box. Single patient use scissors must be wiped with a 70% alcohol wipe between each use and stored in a designated container marked with the patient/client’s name and date of birth so as to ensure that they are only used on the same patient/client. Reusable scissors must be returned to Sterile Services provider following agreed local procedure for decontamination after each use. Speculae - aural Single Use Disposable tips must be used. Dispose of immediately after each use as healthcare waste.

- vaginal Single Use Disposable vaginal specula must be used Dispose of immediately after use as healthcare waste.

-

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Equipment Cleaning Agent Comments Speculae cont. Single Use Disposable scopes must be used. proctoscopes Dispose of immediately after use as healthcare waste. Reusable proctoscopes must be decontaminated in a certified Sterile Services Unit and not in bench top sterilisers. Spoons Single Use Dispose of immediately after use. (used for the administration of medicines) Stethoscopes 70% alcohol Clean at the beginning and end of each session with 70% alcohol wipe. Clean after each patient/client with 70% alcohol wipe.

Suction Apparatus Single Use Dispose of immediately after use. - Catheters

Single Use Change at least daily and between - Tubing patients/clients.

Disposable liners All suction machines must be fitted - Jars with a closed disposable liner system. Disposable liners must be changed as necessary and between patients/clients. Disposable liners must be discarded in rigid appropriately marked containers – contact Community Infection Control Team for further advice.

Wipe outside of apparatus with 70% - machine casing alcohol wipe after each patient/client use. If visibly contaminated with blood/body fluid treat as a spillage. (See Community Infection Control Policy No. 9: Management of Spillages, page 54). Tables / Trays General Purpose The cleaning of these items must be Detergent (GPD) included in the general cleaning schedule of each area. Wash with GPD and hot water. Excessive scratching/scoring of the surface makes cleaning difficult and repair must be carried out or the item discarded. Telephone Handsets General Purpose The cleaning of handsets must be Detergent (GPD) included in the general cleaning 70% alcohol wipe schedule of each area. Wipe with 70% alcohol wipe.

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Equipment Cleaning Agent Comments Thermometers - general Single use Use a disposable system or electronic thermometers with disposable tips/sheaths. Dispose of immediately after use.

- electronic Single use tips/sheaths Use disposable tips/sheaths to cover probe. Wipe casing of thermometer after each use with 70% alcohol wipe.

- oral mercury Single use sheath After removal of sheath wash with 70% alcohol wipe GPD and tepid water. Dry. Wipe with 70% alcohol wipe. Store dry.

- Rectal Single patient/client After removal of sheath wash with use. Single use sheath GPD and tepid water. Dry. Wipe 70% alcohol wipe with 70% alcohol wipe. Store dry in a designated container marked with patient/client name and date of birth, or dispose of immediately after use in a sharps bin. Toys - used in therapy General Purpose See Appendix 8: Toys and Therapy services Detergent (GPD) Services, page 79. 70% alcohol wipe - used in waiting/clinical Toys used in waiting rooms and areas clinical areas must be easy to clean by wiping with hot water and GPD. Surface must then be wiped with 70% alcohol wipe. Soft toys are not suitable for use in these areas. Cleaning of toys must be incorporated into the routine cleaning schedule of each area that provides toys for use by children. Ultra sonic baths See Appendix 9: Use of Bench Top Steam Sterilisers, page 82. Uniforms See Community Infection Control Policy No 3: Use of Protective Clothing, page 16. Vaginal Cones Single patient/client use Wash after each use with general purpose detergent and hot water. Dry with disposable paper towel. Store in a designated container marked with patient/client name and date of birth. Dispose of immediately after patient/client treatment has completed.

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Equipment Cleaning Agent Comments Walking Aids General Purpose On return from patient/client wash E,g. Walking stick, Detergent (GPD) with GPD and hot water. All tape, Walking frame, stickers etc should be removed. If Elbow crutches, visibly soiled treat as a spillage. Fischer stick, (See Community Infection Control Fischer crutches Policy: Management of Spillages, page 54). Dry with disposable paper towel. Store dry. Check for wear and tear. Damaged equipment may be difficult to clean and must be discarded. Wheelchairs General Purpose Wash with GPD and hot water on a In patient/client homes Detergent (GPD) weekly basis or immediately if soiled. Prior to return to Wheelchair Service/Community Equipment Store, wash with GPD and hot water. If visibly soiled treat as a spillage. (See Community Infection On return from General Purpose Control Policy: Management of patient/client Detergent (GPD) Spillages, Page 54). Wash with GPD and hot water. Pay particular attention to grooves/crevices where dust/debris may collect. If visibly soiled treat as a spillage. (See Community Infection Control Policy: Management of Spillages, Page 54). Dry with disposable paper towel. Store dry. Torn or damaged waterproof covering must be professionally repaired/recovered immediately. The wheel chair must be removed from service until this has been completed.

9. Supporting Literature Department of Health.2007. Decontamination of reusable medical devices in the primary, secondary and tertiary care sectors (NHS & Independent providers) 2007 Clarification & Policy Summary. Department of Health.2003. Winning Ways – Working together to reduce healthcare acquired infection. Report from the CMO. London. Department of Health 1999 HSC 1999/179 Controls Assurance in Infection Control: Decontamination of Medical Devices. Hospital Infection Society. 1998. Sterilisation, Disinfection and Cleaning of Medical Equipment: Guidance on decontamination from the Microbiology Advisory Committee to the Department of Health (The MAC Manual). Health Protection Scotland.2007. Model infection Control Policies and The Healthcare Associated Infection & Infection Control Resource Centre. Health Protection Scotland. Medicines & Healthcare Products Regulatory Agency.2006. Decontamination and Infection control.

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Pratt RJ, Pellowe CM, Wilson JA, Loveday HP, Harper PJ, Jones SR, McDougall C, Wilcox M. 2007. epic-2. National evidence based guidelines for preventing healthcare associated infections in England. Journal of Hospital Infection. 65. S1-64. Schabrun & Chipchase. 2006. Healthcare equipment as a source of nosocomial infection: a systematic review. Journal of Hospital Infection. 63. 239-25. July 2006 Further literature on the decontamination of equipment is available from the Community Infection Control Team.

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Management of Waste Community Infection Control Policy No. 8 Planned Review: November 2009

1. Introduction 1.1 The safe disposal of all waste is an essential element of health and safety and general good hygiene. Safe disposal of waste will minimise or avoid the risk of transmission of micro organisms and/or potential infection.

1.2 The safe disposal of healthcare waste especially when it may be contaminated with blood or other potentially infectious body fluids is of particular importance.

1.3 This policy must be read in conjunction with the local Waste Management Policy produced by Estate and Facilities (or waste contractor used by General Medical and General Dental Practitioners) and is intended to complement the guidance in that document.

2. Waste definitions 2.1 Waste produce as a result of healthcare activities is classified as healthcare waste.

2.2 All healthcare waste needs to be segregated so it can be disposed of safely. The Safe Management of Healthcare Waste Memorandum (Department of Health, 2006) introduced a new single classification system to assess if waste is:  Infectious waste  Medicinal waste  Offensive/hygiene waste

2.3 Infectious waste is defined as waste that poses a known or potential risk of infection. All healthcare waste – whether produced in a hospital or a community setting – is assumed to be infectious waste until it has been assessed.

2.4 Medicinal wastes include expired, unused, spilt and contaminated pharmaceutical products, drugs and vaccines for disposal. It also includes discarded items contaminated from use in the handling of pharmaceutics such as bottles/boxes with residues, masks and connecting tubing.

2.5 Cytotoxic and cytostatic waste must be segregated from other medical waste. See table below.

2.6 Offensive waste is a new term to describe waste which is non-infectious and non-hazardous, but which may cause offence to those coming into

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contact with it. For example, incontinence and other products produced from human hygiene, sanitary waste and nappies.

2.7 Healthcare activities in patient/clients homes can create healthcare waste and practitioners must familiarise themselves with the content of this policy, in particular sections 7 and 8.

3. Segregation of Waste Waste receptacle Waste Type Example Contents Yellow Sack & purple Infectious waste Dressings/tubing from stripe contaminated with cytotoxic or cytostatic cytotoxic products treatment Not sharps. Sharps bin – Purple lid Sharps contaminated with Sharps used to administer cytotoxic and cytostatic cytotoxic products. medicinal products Yellow Sharps bin Partially discharged Syringe body & needle with sharps not contaminated residual medicinal products. with cytotoxic products Yellow Sacks Infectious and other waste All healthcare waste requiring incineration produced in hospital or including anatomical community settings is waste, diagnostic assumed to be infectious specimens waste until it has been assessed. Anatomical waste from theatres Orange sacks Infectious waste and Soiled dressings potentially infectious waste Yellow sacks & black Offensive/hygiene waste Human hygiene waste and stripe non infectious disposable equipment e.g. bedding Black bag Domestic waste General Refuse White container Amalgam waste Dental amalgam waste To be collected by licensed waste carrier. Adapted from: Waste packaging and colour-coding in Department of Health Environment and Sustainability – HTM 07-01: Safe Management of Healthcare Waste.2006

4. Roles & Responsibilities 4.1 All Staff  Have a responsibility to dispose of waste appropriately.  Have a responsibility to perform hand hygiene after handling and/or disposal of waste (see Community Infection Control Policy No.2: Hand Hygiene, page 9).  Have a responsibility to wear appropriate protective clothing during the creation, handling and disposal of waste (see Community Infection Control Policy No.3: Use of Protective Clothing, page 15).  Have a responsibility to attend training on the appropriate disposal of waste.

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 Have a responsibility to report adverse incidents relating to the disposal of waste via the incident reporting scheme of the organisation concerned.  Have a responsibility to risk assess the disposal of healthcare waste generated by healthcare activities in the homes of patients/clients and take appropriate action.

4.2 Managers  Have a responsibility to ensure that all staff have receive training on the management of waste ( contact Estates and Facilities – see Local Contacts, page 5)  Must ensure that adequate resources are available for appropriate waste disposal, this includes the provision of sufficient, design compliant bins (See section 5 below: General Good Practice).  Ensure that staff have undertaken risk assessments relating to the disposal of healthcare waste generated by healthcare activities in the home of patients/clients.  Must ensure that the cleaning of bins is included in the routine cleaning schedule of each area.  Ensure that staff have access to appropriate protective clothing. (See Community Infection Control Policy No.3: Use of Protective Clothing, page 15).  Ensure that staff have access to hand hygiene facilities (see Community Infection Control Policy No. 2: Hand Hygiene, page 9).  To take timely remedial action (in collaboration with Estates and Facilities, Risk Management and Community Infection Control Team as necessary) after an incident involving the incorrect disposal of waste.

5. General Good Practice. 5.1 Dispose of waste immediately, as close to the point of use as possible, into the appropriate container.

5.2 Waste bins in healthcare premises must be hands free or foot operated, and made of a non-combustible material that encloses the waste sack completely.

5.3Healthcare waste bags must be UN approved standard

5.4 Sharps containers must be UN approved standard (see Community Infection Control Policy No.5: The Prevention of Sharps Injury, page 25).

6. Storage and Transport 6.1 Store unused clean waste bags/containers in a clean area until needed.

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6.2 Store filled waste bags/containers in an upright position, in a designated area that is protected from the elements and is not accessible by vermin, dogs, cats or the general public.

6.3 Domestic waste must be stored separately from other waste.

6.4 Waste storage should not be near clinical or food preparation areas.

6.5 All waste sacks/containers must be sealed with a non-return identification tag.

6.6 Sharps boxes must be locked prior to disposal and marked with an identification tag (see Community Infection Control Policy No.5: The Prevention of Sharps Injury, page 25).

6.7 Filled waste sacks must be handled by the neck only.

6.8 Sealed sharps boxes must be carried by the handle only and should be kept upright during transportation.

6.9 Staff involved in the disposal and/or transportation of waste must be familiar with Community Infection Control Policies No. 6: The Management of Sharps (page 30, Needlestick and Splashing Incidents (page 32).

6.10 Staff involved in the disposal and / or transportation of waste must be familiar with Community Infection Control Policy No. 9: Management of Spillages of Blood and/or Body Fluids, page 66.

7. Disposal of Healthcare Waste generated in Patient/Client’s Homes 7.1 With the exception of community sharps bins (see Section 8.of this policy: Disposal of Sharps used in Patient/Client’s Homes) staff must not be transporting clinical waste between health centres and patient/client’s homes.

7.2 Where possible the local authority clinical waste service (LACWS) must be used to collect healthcare waste from the homes of patients/clients in Newham and Tower Hamlets. See Local Contacts.

7.3 CHPCT staff must contact ‘Cliniserve ‘on 01243 782288 ext 214 to arrange collection of waste from patient/client’s homes.

7.4 CHPCT staff must contact the Facilities Manager 020 7683 4280 or the Domestic Manager on 020 7383 4342 for collection of waste from schools following immunisation sessions.

7.5 If healthcare waste collection cannot be arranged, the service manager must produce a written risk assessment in collaboration with the Risk

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7.6 Management team of the employing organisation prior to staff transporting healthcare waste in private vehicles.

7.7 Using the LACWS must take into account the volume and degree of contamination of healthcare waste generated:  Waste that is grossly contaminated with blood and/or body fluids must be placed into orange waste sacks and collected by the LACWS.  Wound drains must be placed into an orange waste sack (or sharps bin if ‘sharp’) and collected by the LAWCS.  Volume of waste greater than can be collected in the disposal bag provided in dressing packs/dressing aids must be collected by the LAWCS  Sharps bins used in patient/client’s homes must be collected by the LAWCS.  Placentas from home births must be sealed in specifically designed and marked placenta bins and collected by the LAWCS. Placentas must not be disposed of in waste sacks due to the amount of blood present. All other waste generated during a home birth must be placed in orange waste sacks and/or sharps bins as appropriate.  Cytotoxic waste must be disposed of in appropriately marked sacks and/or sharps containers and collected by the LAWCS.

7.8 Stoma/catheter drainage bags can be disposed of black bag (domestic waste) whilst a healthcare worker is attending the patient/client. If however, bulk waste is generated, the patient/client develops a site infection or gastrointestinal infection the waste must be disposed of in orange waste sacks and collection by LAWCS arranged by the healthcare worker.

7.9 Patients/clients self managing their stoma or catheter can place waste into the black bag (Domestic) waste stream.

7.10 All other health care waste (not sharps) must be placed into the plastic bag provided with the dressing pack/aid or into a small carrier bag. This bag must then be placed in another plastic bag or wrapped in newspaper prior to being disposed of as domestic waste.

8. Disposal of Sharps used in Patient/Client’s Homes 8.1 Staff likely to use ‘sharps in the course of a home visit must carry a community sharps bin (see Community Infection Control Policy No.5: The Prevention of Sharps Injury, Page 25). This sharps bin must be closed at all times during transportation and returned to the health centre/clinic for disposal when no more than 2/3rds full.

8.2 Those patients/clients who regularly receive treatment that involved the use of sharps must be provided with a sharps bins and arrangements

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made by the healthcare worker for collection and replacement of the sharps bin by LAWCS as necessary.

Prior to leaving a sharps bin at the home of patient/client the healthcare professional must conduct a risk assessment, ensuring that safe storage (e.g. inaccessible to children and in a manner that avoids spillage) can be achieved. In those instance where the health professional considers it unsafe to leave a sharps bin in the patient/client’s home a community sharps bin must be used for disposal of sharps and removed by the health professional after each treatment.

Self medicating patients/clients using sharps must have received education about the importance of safe disposal of sharps prior to prescription of the sharps box. This education must include information about storage and local disposal options for example, return to GP Practice, health centre or local pharmacy for disposal and replacement, or the use of the LAWCS.

The method of sharps disposal by self medicating patients/clients must form part of their regular patient review.

9. Supporting Literature Department of Health .2006. Environment and Sustainability – HTM 07-01: Safe Management of Healthcare Waste. London Royal College of Nursing.2007. Safe Management of Healthcare Waste. RCN Further information on waste disposal and the control of infection is available from Community Infection Control Team.

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Management of Spillages of Blood and/or Body Fluids Community Infection Control Policy No: 9 Planned Review November 2009

1. Introduction 1.1 Spillages of blood and/or body fluids pose a potential risk of infection to those who may be exposed whilst providing and/or receiving healthcare.

1.2 Spillages of blood and/or body fluids must be dealt with as quickly as possible following the guidance outlined in this policy.

1.3 The person discovering the spill assumes responsibility for ensuring that the spill is dealt with immediately.

2. Roles and Responsibilities 2.1 All staff must:  Secure the Hepatitis B vaccine (contact Occupational Health – see local contacts, page 5).  Apply the guidance outlined in this policy when dealing with spillages of blood and/or body fluids.  Familiarise themselves with the contents of this policy on a regular basis.  Wear appropriate protective clothing (see Community Infection Control Policy No. 3: Use of Protective Clothing, page 15) when dealing with blood and/or body fluid spillages.  Apply the principles of good hand hygiene (See Community Infection Control policy No. 2: Hand Hygiene, page 9).  Report to Line Manager any deficits in knowledge of management of spillages of blood and/or body fluids, facilities /equipment or incidents that may result in cross contamination.  Report any incidents involving exposure to blood or body fluids in accordance with the Accident and Incident Reporting Policy of each PCT.

2.2 Managers must:  Ensure that all staff contact Occupational Health about hepatitis B vaccination (See Community Infection Control Policies No. 1: Standard Precautions, page 7 and No.4: Occupational Health & the Control of Infection, page 23).  Ensure that all staff working in areas used by patients/clients have had instruction /education on the principles of managing spillages of blood and body fluids.  Ensure that sufficient resources are in place to allow the safe management of spillages of blood and/or body fluids.  Ensure that all staff have access to appropriate protective clothing.

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 Ensure that all staff, in all settings, have access to materials that will allow effective hand hygiene to take place (see Community Infection Control Policy No. 2: Hand Hygiene, page 9).

3. General Good Practice 3.1 Spillages must be dealt with immediately.

3.2 The person discovering the spill assumes responsibility for ensuring that the spill is dealt with immediately.

3.3 The equipment needed to deal with a spillage must be gathered prior to dealing with the spillage. (See section 5 of this policy, Spillage Kits, page 56).

4. Cleaning of Spillages of Blood and/or Body Fluids 4.1Ensure that all cuts and/or abrasions on exposed areas of the body are covered with waterproof dressings.

4.2Wear appropriate protective clothing. Wear eye protection if there is likely to be splashing (see Community Infection Control Policy No.3: Use of Protective Clothing, page 15).

4.3If the spillage of blood or blood stained body fluid is easily confinable, hypochlorite granules must be sprinkled liberally over the spill and left for 2 minutes. The solidified granules must then be removed with disposable paper towels and discarded as healthcare waste.

4.4 Warning. Hypochlorite granules must only be used to deal with easily containable blood spillages including body fluids visibly stained with blood). Hypochlorite granules should be used in well ventilated areas only.

4.5 If the spillage is not easily confinable or is not visibly blood stained then hypochlorite solution must be used (see Section 6 of this policy, Preparation & Use of Hypochlorite Solutions, page 56)  Prepare the hypochlorite solution (see section 6 of this policy Preparation & Use of Hypochlorite Solutions, page 56).  Cover the spillage with paper towels to limit the spread of the spillage and the hypochlorite solution.  Pour the hypochlorite solution onto the covered spillage.  Wipe up the spillage with more paper towels soaked in hypochlorite solution.  Dispose of in the yellow infectious waste stream.

4.4Wash the floor/surface with general purpose detergent and hot water.

4.5Remove protective clothing and dispose of in the yellow infectious waste stream. If worn, eye protection must be washed with general purpose detergent and stored dry.

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4.6Wash hands with liquid soap and warm water. (See Community Infection Control Policy No.2: Hand Hygiene, page 9).

5. Spillage Kits 5.1 A spillage kit must be available in all areas where patients/clients are seen. As a minimum the kit must contain:  A laminated guidance sheet on how to deal with spillages.  Hypochlorite granules and hypochlorite tablets – both of these must be in their original packaging.  Protective Clothing (powder free latex gloves, plastic aprons and eye protection).  Paper towels.  Mixing/measuring jug for hypochlorite solutions.  Yellow infectious waste bags.

5.2 The kit must be kept in a locked cupboard. All staff must be aware of the location of the spillage kit.

5.3 Spillages kits must be replenished immediately after use and any reusable equipment stored clean and dry.

5.4 Commercial spillage kits are also available. These will also require replenishment immediately after use.

6. Preparation and Use of Hypochlorite Solutions

Hypochlorite Strengths To prepare Uses Preparations Actichlor; Presept or To make 10,000ppm 7 Tablets in one Decontamination of blood Haz-tab 2.5g tablet solution litre of water and blood stained body fluid spills. Haz-tab 4.5g tablet To make 10,000ppm 4 tablets in 1 litre of Decontamination of blood solution water (use the and blood stained body fluid diluter provided). spills. Acti-chlor; Presept or To make 1,000ppm 4 tablets in 5 litres Decontamination of surfaces Haz-tab 2.5g tablet solution of water that may be lightly (i.e. not visibly contaminated with blood) contaminated. Haz-tabs 4.5g To make 1,000ppm 1 tablet in 2.5 litres Decontamination of surfaces solution water (use the that may be lightly (i.e. not diluter provided) visibly contaminated with blood) contaminated. Domestic bleach To make 10,000ppm Dilute 1:10 in Decontamination of blood (for use in solution water. (Add bleach and blood stained body fluid patient/client’s home) solution to water & spills. not vice versa) Do not use on soft furnishing in patient/clients own home. Domestic bleach To make 1,000ppm Dilute 1:100 in Decontamination of surfaces (for use in solution water. (Add bleach that may be lightly (i.e. not patient/client’s home) solution to water & visibly contaminated with not vice versa) blood) contaminated.

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6.1 The above table is intended as a guide only – always refer to manufacturer’s instructions for dilution on original product packaging.

6.2 It is essential to use the correct concentration to disinfect the area where the spillage has occurred. Contact the Community Infection Control Team for further advice as necessary.

6.3 Protective clothing should be worn in the preparation of hypochlorite solutions.

6.4 Unused hypochlorite solution must be discarded immediately after use.

7. Supporting Literature Chitnis V, Chitnis P, Patil S, Chitnis D. 2004. Practical limitations of disinfection of body fluid spills with 10,000ppm sodium hypochlorite. American Journal of Infection Control. 32(5) 306-308. Department of Health.2004. HIV Post-exposure prophylaxis. Revised guidance from the UK Chief Medical Officer’s Expert Advisory group on Aids. Department of Health. London. Health Protection Scotland.2008. Literature review – Management of Spillages of Blood. www.hps.scotland. Health & Safety Executive. 2002. The Control of Substances Hazardous to Health Regulations. HMSO. London UK Health Departments.1998. Guidance for clinical healthcare workers: protection against infection with blood-borne viruses. Recommendations of the Expert Advisory group on AIDS & the Advisory group on hepatitis. Department of Health. London. .

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Managing the Environment Community Infection Control Policy No.10 Planned Review November 2009

1. Introduction 1.1 Health and social care settings contain a diverse population of micro organisms and inevitably areas shared by different patients/clients will become contaminated. In order to limit the creation of potential reservoirs of harmful micro organisms (which may contribute to healthcare associated infection) it is important to manage the environment by appropriate cleaning and decontamination. (see Community Infection Control Policy No.7, Management of Healthcare Equipment, page 33).

2. Roles & Responsibilities 2.1 All Staff  Must practice hand hygiene as outlined in Community Infection Control Policy No.2: Hand Hygiene, page 10.  Have a responsibility to ensure that their working environment is clean and fit for purpose.  Must be aware of the cleaning schedules for their working environment.  Must highlight deficiencies in the implementation/application of cleaning schedules to their line manager.  Must report damaged wall, floors, surfaces immediately to their line manager for repair.  Must regularly review all equipment and furniture in their working environment. Damaged equipment must be removed from use and referred to the line manager for repair or disposal.

2.2 Managers  Have a responsibility to ensure that staff have access to facilities that will allow effective hand hygiene to take place (see Community Infection Control Policy No.2: Hand Hygiene, page 9).  Have a responsibility to ensure that the environments in which staff are working and/or patients/clients use are clean and fit for purpose.  Have a responsibility to ensure that cleaning schedules for each area are defined, documented and displayed.  Have a responsibility to ensure that cleaning is carried out in accordance with these cleaning schedules Have a responsibility to review cleaning schedules on a regular basis in collaboration with cleaning staff/company, staff working in each area and Facilities Manager (where appropriate).

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 Have a responsibility to address any deficiencies in the implementation/application of cleaning schedules with cleaning staff direct or via Facilities Manager as appropriate.  Have a responsibility to ensure that damaged equipment and/or furniture is removed from use and repaired or disposed of.

3. General Good Practice 3.1 The healthcare environment must be visibly clean, free from dust and spillages and acceptable to patients/clients, visitors and staff.

3.2 A tidy clutter free environment is important so as to ensure that thorough cleaning can be undertaken.

3.3 Areas must be reviewed regularly. Damaged walls, floors and/or surfaces must be repaired immediately. Damaged equipment and/or furniture must be removed from use and sent for repair or appropriate disposal. (see also Community Infection Control Policy No.7: Managing Healthcare Equipment, page 33).

3.4 Cleaning staff must wear appropriate protective clothing, (see Community Infection Control Policy No.3: Use of Protective Clothing, page 15) and carry out hand hygiene as necessary (see Community infection Control Policy No.2: Hand Hygiene, page 9).

3.5 Equipment used for cleaning the environment must be clean, fit for purpose and in a good state of repair. Mechanical cleaning equipment e.g. vacuum cleaners, steam cleaners etc must be subject to a planned preventative maintenance schedule.

3.6 Equipment used for storage e.g. shelves, units, lockers must have easy to clean surfaces that are impermeable to water, with as few as possible crevices so as to facilitate cleaning.

3.7 Change of function/use for rooms /departments will require a review of the cleaning schedule, prior to implementation of change.

3.8 Cleaning of equipment, flooring and/or furniture must be considered prior to purchase. Contact the Community Infection Control Team as necessary.

3.9 Liaison with Estates and Facilities (see Local Contacts, page 5) is an important element in the management of the environment. Air conditioning unit, vents, filters, refrigerators, windows, water coolers etc must all be part of a planned preventative maintenance programme for each area. (See also Community Infection Control Policy No. 7: Management of Healthcare Equipment, page 33).

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4. Supporting Literature Boyce JM.2007. Environmental contamination makes an important contribution to hospital infection. Journal of Hospital Infection. 65. 50-54. Department of Health.2008. Clean, Safe care. Reducing Infections & Saving Lives. NHS. London. Department of Health.2006 The Health Act 2006. Code of Practice for the prevention and control of healthcare associated infection. London. NHS Estates. The NHS Cleaning Manual.2004. Department of Health. London. Pratt RJ, Pellowe CM, Wilson JA, Loveday HP, Harper PJ, Jones SR, McDougall C, Wilcox M. 2007. epic-2. National evidence based guidelines for preventing healthcare associated infections in NHS hospitals in England. Journal of Hospital Infection. 65. S1-64.

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Appendix 1

Reporting Outbreaks and/or Unusual Incidents Community Infection Control Policy 2008 Planned Review: November 2009

1. Introduction 1.1 Seek early advice if your clinical judgement causes you to suspect an outbreak of infection or unusual incident that could be linked to infection.

2. What to report 2.1 Report the following to the Community Infection Control Team during working hours:  An increased incidence of vomiting and/or diarrhoea occurring over either a short period or extended period amongst staff and/or patients/clients.  Several cases of similar infection (based on clinical diagnosis) in patients/clients or staff who have contact with each other.  An unusually large number of absence due to illness amongst staff, whether or not the cause is known.

2.2 Incidents involving staff must also be notified to the appropriate Occupational Health Department (see Local Contacts, page 5)

2.3 Any clinician who sees patients/clients with symptoms of food poisoning and a food history indicating a possible link to food supplied from commercial premises must contact the local Environmental Health Department and the North East and North Central London Health Protection Unit without delay (see Local Contacts, page 5).

3. Reporting During working hours (Mon-Fri 0900-1700) Contact: The Community Infection Control Team: 020 8223 8009 (If an answer phone response, please contact a team member via mobile telephone – numbers are listed in Local Contacts)

Out of hours (including Bank holidays and weekends) Contact: The Health Protection Unit l: 07623 541 417 Leave a message and contact number if required (If you do not receive a response within 20 minutes please call again)

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Appendix 2

Storage of Vaccines Community Infection Control Policy Planned Review November 2009

1. Introduction 1.1 Correct storage and maintenance of the cold chain are vital to ensure vaccine efficacy at the time of use. The term ‘cold chain’ refers to the system of transporting and storing vaccines within the safe temperature range of 2°c - 8°c.

2. Responsibilities 2.1 Managers  Have a responsibility to provide appropriate equipment for the storage and maintenance of vaccine cold chain.  Have a responsibility to identify designated personnel responsible for the maintenance of the cold chain (including receipt of vaccines and temperature control) and stock management.  Have a responsibility to ensure that designated personnel are appropriately trained in these duties.  Have a responsibility to ensure that procedures are in place and known to all users in the event of system failure or adverse incident.

2.2 Staff  All staff have a responsibility to follow the guidance outlined in this document.  Designated personnel have a responsibility to ensure that daily temperature readings are recorded on all working days in a dedicated log book.  Designated personnel have a responsibility to report immediately abnormal temperature readings to the local pharmacy department.  Have a responsibility to ensure that efficient stock management (including stock rotation) is in place.

3. Storage 3.1 Use a dedicated vaccine fridge, supplied by a recognised medical supplier.

3.2 The vaccine fridge must be locked when not in use.

3.3 Food and/or medical supplies must not be stored in the vaccine fridge.

3.4 The vaccine fridge must be no more than 50% full, allowing air to circulate around packs.

3.5 Do not store vaccines in the door of the fridge.

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3.6 A system of stock rotation must be in place.

3.7 The vaccine fridge must be defrosted and calibrated at regular intervals.

4. Temperature Control 4.1 A maximum/minimum thermometer must be used.

4.2 Temperatures must be recorded on all working days (taking a reading from the moveable indices and an actual reading from the mercury level).

4.3 Temperatures must not exceed 8°c or fall below 2°c. A reading of 5°c allows a safety margin of + or - 3°c.

4.4 Temperature readings outside the recommended range must be reported immediately to the local Pharmacy Department (see Local Contacts, page 5) who will advise on action to be taken.

4.5 Temperatures must be recorded and records stored safely for a minimum of 8 years.

4.6 A sample chart for the recording of vaccine fridge temperature is included in this guidance.

5. Transportation

5.1 Vaccines must be transported in validated cool boxes and ice packs from recognised medical suppliers.

5.2 Vaccines must be wrapped to prevent direct contact with ice packs.

5.3 Use insulating material to fill any spaces in cool box.

5.4 Only take enough vaccine for session and minimise exposure of vaccine to room temperature.

5.5 Cool boxes must be cleaned weekly with warm water and general purpose detergent.

6. Spillages 6.1 Spillages of vaccine must be dealt with as quickly as possible following the guidance outlined in ‘Spillages of Blood or Body Fluids’.

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7. Disposal 7.1 Unused vaccine that has been out of the fridge for 2 or more sessions must be returned to the local Pharmacy Department for destruction.

7.2 Any prepared or partially used vaccines must be destroyed at the end of each session. Dispose of in sharps disposal bin.

Sample Chart for the Recording of Vaccine Fridge Temperature

MONTH

Date Current Minimum Maximum Checked By &Time Temperature Temperatur Temperatur e e

Fridge defrosted and cleaned: ……………………………………………………..

Date…………………………..Signed……………………………………………….

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Appendix 3

Food Handling Community Infection Control Policy Planned Review November 2009

1. Introduction 1.1 The definition of a food handler, in the context of this policy, is a member of staff who handles or prepares food and/or beverages for persons other than themselves in the course of their work in areas other than main catering departments. A separate detailed policy should be available in all catering departments.

2. Responsibilities 2.1All staff  All staff has a responsibility to maintain a high standard of personal and general hygiene so as to avoid causing cross contamination in the handling of food and/or beverages. (See Community Infection Control Policy No.2, Hand Hygiene, page 9 and section 3 of this Appendix - Hand Hygiene).  All staff has a responsibility to report potentially infectious illnesses whilst on duty to their line manager and seek advice from Occupational Health (e.g. diarrhoea, vomiting, throat infections, unexplained skin rashes, boils or other skin lesions should be reported).  Episodes of diarrhoea and/or vomiting lasting 48 hours or longer during holiday periods must be reported to Occupational Health and line manager on return to work.  To attend food hygiene courses as required.  To report any deficits in the implementation of cleaning schedules and/or recording of temperatures of refrigerators and freezers.  To report any deficits in the performance of equipment e.g. dishwashers, refrigerators or freezers immediately to the line manager

2.2 Managers  To seek (and act on) advice from Occupational Health regarding the appropriate exclusion of food handlers.  To provide facilities that allows staff to maintain a good standard of personal and general hygiene.  To ensure staff have access to, and attend, food hygiene courses at regular intervals.  To provide facilities for staff changing.  To ensure that refrigerators and freezers are included in the routine cleaning schedule for each area

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 To designate team members responsible for recording daily temperatures on both refrigerators and freezers.  To ensure that planned preventative maintenance programmes are in place for refrigerators, freezers and dishwashers.

3. Hand Hygiene 3.1 See Community Infection Control Policy No. 2: Hand Hygiene, page 9.

3.2 Designated hand washing sinks must be available in all food preparation/ serving areas.

3.3 Hands must be washed:  On entry to food area.  Before food preparation.  After touching food.  After handling food waste.  After cleaning.  After touching face/blowing nose etc.

4. Use of Protective Clothing 4.1 See Community Infection Control Policy No. 3: Use of Protective Clothing, page 15.

4.2 As a minimum a clean plastic apron must be worn over clothing. Hair must be tied back. Other protective clothing may be required in food preparation areas – refer to local guidance.

4.3 Catering uniform and/or protective clothing must not be worn outside catering areas.

5. Refrigerators & Freezers 5.1 Temperatures must be recorded on a daily basis.

5.2 Refrigerators have a running temperature of 0°c - 5°c any temperatures recorded outside these parameters must be reported immediately to line manager.

5.3 Freezers have a running temperature between -18° and -21°c any temperatures recorded outside these parameters must be reported immediately to line manager.

5.4 Refrigerators and freezers must be defrosted and cleaned on a regular basis. This must be part of the routine cleaning schedule for each area.

6. Working Area & Equipment 6.1 Food preparation/serving areas must be kept clean. Surfaces including work tops, walls ceilings and floors must be smooth, impervious to fluids and corrosion resistant.

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6.2 Equipment must be kept clean and dry.

6.3 Crockery, cutlery and other utensils must be washed in a dishwasher and allowed to air dry. Tea towels must not be used.

6.4 Cleaning of dishwashers must be included in the routine cleaning schedule for the area.

6.5 Dishwashers must be subject to routine maintenance - Estates and Facilities will advise on the necessary frequency – See Local Contacts, page 5.

7. Food Stock Storage & Rotation 7.1 All food must be wrapped and stored as required. All food must be labelled showing the date of opening and rewrapping, prior to storage.

7.2 Prior to use, all food items must be checked for date of production, quality (mould, discolouring) ‘Best by’ date and ‘Use by’ dates. Food that does not allow these criteria to be checked must be discarded.

7.3 Opened dry food must be stored in pest proof containers, again these must be dated with the date of opening.

7.4 Storage of food in a refrigerator must ensure that cooked foods are always stored above uncooked items,

7.5 Cleaning chemicals and materials must not be stored in areas where food is handled/prepared.

8. Waste Disposal 8.1 Waste bins should be emptied regularly. Waste bins must be kept clean and should be included in the routine cleaning schedule for each area.

Broken items of crockery, glassware etc, must be placed in a cardboard box, taped and marked ‘Domestic/Household Sharp.

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Appendix 4

Care of Central Venous Devices in the Community Community Infection Control Policy 2008 Planned Review November 2009

1. Introduction 1.1 Although infections in central vascular devices are rare, they are often serious when they occur and can result in death. Meticulous hygiene when handling these devices is essential to reduce the incidence of these infections.

2. Roles & Responsibilities 2.1 All staff must:  Always wash hands thoroughly and disinfect with an alcohol hand rub before handling any parts of the device (See Community Infection Control Policy No.2: Hand Hygiene, page 9).  Use sterile gloves for handling any part of the device.  Ensure that they have been assessed as competent in using and adhering to infection control practices related to the care of central venous devices.  Ensure that communication between community and hospital teams managing the care of the patient/client and management of the central venous device is open and regular.  Ensure that catheter site care is compatible with catheter materials (tubing, hubs, injection ports, luer connections) by referring to manufacturer’s recommendations.

2.2 Managers must:  Ensure that staff caring for patients/clients with central venous devices are trained and assessed as competent in using and consistently adhering to the infection prevention practices outlined in this policy.  Ensure that competency assessments are carried out on at least a yearly basis and that records of training and competency assessments are maintained.  Ensure that staff has access to appropriate protective clothing (see Community Infection Control Policy No.3: Use of Protective Clothing, page 15).  Ensure that staff has access to facilities that will allow effective hand hygiene to take place (see Community Infection Control Policy No.2: Hand Hygiene, page 9).

3. Care of Insertion Site 3.1 Sterile gloves and disposable plastic apron must be worn when caring for the insertion site.

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3.2 An aseptic no touch technique must be used.

3.3 A sterile transparent semi-permeable polyurethane dressing must be used to cover the catheter insertion site.

3.4 Transparent dressings must be changed every 7 days or sooner if they are no longer intact or moisture has collected under the dressing.

3.5 If the patient/client has profuse perspiration or if the insertion site is bleeding or oozing, a sterile gauze dressing is preferable to a transparent semi-permeable dressing.

3.6 Need for gauze dressing must be assessed daily and changed when inspection of insertion site is necessary or when the dressing becomes damp loosened or soiled.

3.7 Gauze dressings must be replaced by transparent dressings as soon as possible.

3.8 Alcoholic chlorhexidine gluconate (2% chlorhexidine gluconate in 70% isopropyl alcohol) must be used to clean catheter during dressing changes. Allow to air dry. An aqueous solution of chlorhexidine gluconate must be used if the manufacturer’s recommendations prohibit use of alcohol with their product.

3.9 Individual sachets of solution or single use antiseptic wipes must be used to disinfect the catheter site.

3.10 The site must be inspected daily. The patient/client can be taught to do this. Any signs of infection such as swelling, redness, pain or purulent discharge must be promptly reported to the GP or the hospital responsible for patient/client’s care.

3.11 Antimicrobial ointments must not be used routinely on insertion sites.

4. Handling the Central Venous Device 4.1 Always wear sterile gloves and use an aseptic no-touch technique when handling the catheter and any components/attachments.

4.2If needle free devices are used to access the central venous catheter, these (and their components) must be changed according to manufacturer’s instructions.

4.3 Staff must ensure that all components of needle free devices are compatible and secured to minimize leaks and/or breaks in the system.

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4.4 Where needle free devices are used the risk of contamination must be reduced by decontaminating access ports before and after use with a single patient use sachet or wipe of alcoholic chlorhexidine gluconate (2% chlorhexidine gluconate in 70% isopropyl alcohol). Ensure that the manufacturer’s recommendations do not prohibit the use of alcohol based products.

5. Administration Sets 5.1 Solution administration sets in continuous use must be replaced every 72 hours (unless they become disconnected, in which case they must be changed immediately).

5.2 Administration sets used for blood and/or blood components must be changed when transfusion is complete or every 12 hours (if sooner) or according to manufacturer’s instructions.

5.3 Administration sets used for TPN should be changed every 24 hours.

6. Supporting Literature

Department of Health 2003, Winning Ways: working together to reduce healthcare associated infections. Report from the Chief Medical Officer. London. National Institute for Clinical Excellence. 2003. Infection Control. Prevention of healthcare associated infections in primary and community care. NICE Pratt RJ, Pellowe CM, Wilson JA, Loveday HP, Harper PJ, Jones SR, McDougall C, Wilcox M. 2007. epic-2. National evidence based guidelines for preventing healthcare associated infections in NHS hospitals in England. Journal of Hospital Infection. 65. S1-64.

Further information on central venous devices and the control of infection are available from the Community Infection Control Team.

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Appendix 5

Enteral Feeding in the Community Community Infection Control Policy 2008 Planned Review November 2009

1. Introduction 1.1 Enteral feeding systems are susceptible to microbial contamination, which may result in systemic infection, especially in vulnerable or immuno- compromised patients. For example the National Institute of Clinical Excellence (NICE) found that 30% of feeds were contaminated with a variety of micro organisms, largely due to poor preparation or poor administration of feeds, with rates of contamination highest in home settings (NICE,2003). These risks can be minimized by following the guidance outlined in this document.

2. Roles & Responsibilities 2.1 All staff must:  Always wash hands thoroughly and disinfect with an alcohol hand rub before and after caring for the insertion site, preparing feeds or handling any parts of the system (See Community Infection Control Policy No.2: Hand Hygiene, page 9).  Wear appropriate protective clothing (see Community Infection Control Policy No.3: Use of Protective Clothing, page 15).  Ensure that they have been assessed as competent in using and adhering to infection control practices related to enteral feeding.  Be aware of the content of training /education that patients/clients received in hospital so that this can be reinforced appropriately.  Ensure that communication between community and hospital teams managing the care of the patient/client is regular and detailed.  Ensure that equipment marked as ‘Single Use’ is not reused.

2.2 Managers must:  Ensure that staff caring for patients/clients receiving enteral feeding is assessed as competent in using and consistently adhering to the infection prevention practices outlined in this policy.  Ensure that competency assessments are carried out on at least a yearly basis and that records of training and competency assessments are maintained.  Ensure that staff has access to appropriate protective clothing (see Community Infection Control Policy No.3: Use of Protective Clothing, page 15).

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 Ensure that staff has access to facilities that will allow effective hand hygiene to take place (see Community Infection Control Policy No.2: Hand Hygiene, page 9).  Ensure that staff has the opportunity to liaise with hospital teams with regard to education and training of patients/clients in this area.  Ensure that sufficient resources are available to ensure that single use equipment is not reused.

3. Preparation and Storage of Feeds 3.1 Where possible pre packaged ready-to-use feeds must be used in preference to feeds requiring decanting, reconstitution or dilution.

3.2 System selected must require minimum handling to assemble and be compatible with enteral feeding tube.

3.3 If unavoidable, decanting, reconstitution or dilution must take place in a clean working area, using equipment dedicated for use with enteral feed only.

3.4 Feeds must be mixed with cooled boiled or sterile water using a no-touch technique.

3.5 Feeds must be stored in accordance with the manufacturer’s instructions.

3.6 Do not add medication or other substances directly into the feed container.

4. Administration of Feeds 4.1 Hand hygiene must be carried out before and after administration of feeds. (See Community Infection Control Policy No. 2: Hand Hygiene, page 9).

4.2 Protective clothing (gloves and aprons) must be worn (see Community Infection Control Policy No. 3: Use of Protective Clothing, page 15).

4.3 Minimal handling and an aseptic no-touch technique must be used to connect the feed container, administration system and enteral feeding tube.

4.4 The number of connections in the system must be kept to a minimum.

4.5 Ready to use feeds can be given for a whole administration session up to a maximum of 24 hours.

4.6 Reconstituted feeds must be administered over a maximum 4 hour period.

4.7 Ensure that the feeding system is labelled with the date and time feed commenced.

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4.8 Administration sets and feed containers marked as single use must be discarded after each feed.

5. Care of Insertion Site 5.1 Wash stoma daily with water and dry thoroughly. A dressing is only required if the site is oozing.

5.2 Enteral feeding tubes must be flushed with tap water before and after feeding or administration of medicines.

5.3 Enteral feeding tubes for immuno- suppressed patients must be flushed with either cooled freshly boiled water or sterile water. Please note: part used containers of sterile water must be discarded every 24 hours.

6. Supporting Literature Department of Health. 2007 Essentials to Safe Clean Care, Enteral Feeding. London. National Institute for Clinical Excellence. 2003. Infection Control. Prevention of healthcare associated infection in primary and community care. NICE.

Further information on enteral feeding and the prevention of infection is available from the Community Infection Control Team.

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Appendix 6

Handling and Collection of Specimens Community Infection Control Policy 2008 Planned Review November 2009

1. Advice can also be sought from the Laboratory (see Local Contacts, Page 5).

2. Roles and Responsibilities 2.1 All staff  Have a responsibility to handle and collect specimens according to best practice.  Have a responsibility to carry out appropriate hand hygiene (see Community Infection Control Policy No.2: Hand Hygiene, page 9) in relation to the handling and collection of specimens.  Have a responsibility to use appropriate protective clothing (see Community Infection Control Policy No.3 Use of Protective Clothing, page 15) when handling and/or collecting specimens.  Have a responsibility to secure the Hepatitis B vaccine (this includes reception and/or other staff who handle specimens in the course of their work).  Must receive appropriate training in the handling and collection of specimens.

2.2 Managers  Are responsible for ensuring the provision of Hepatitis B vaccine followed by a titre check to establish immune status, free of charge, to all staff at risk of exposure to blood and/or body fluids in the course of their duties - the handling and collection of specimens fall into this category.  Have a responsibility to ensure that staff has access to appropriate protective clothing.  Have a responsibility to ensure that facilities that will allow effective hand hygiene are available.  Have a responsibility to ensuring that staff receive training in the handling and collection of specimens.  Must ensure that staff has access to the Pathology Handbook either via the intranet or hard copy.

3. Handling of Specimens 3.1 Disposable non sterile latex gloves must be worn to handle specimen containers.

3.2 Specimen containers must be packed into individual self-sealable or heat sealed plastic bags before being transported to the laboratory. The request form must be placed in the separate pocket of the bag.

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3.3 Ensure that the information on both the specimen and the request form is accurate.

3.4 Do not put more than one specimen and one form in each bag.

3.5 In areas where specimens are collected from a central point, the following points must apply:  Patients/clients presenting specimens at reception must be asked to place them directly into the appropriate plastic bag. Staff must then seal the bag and place request form in separate pocket prior to collection.  Leaking specimens must not be accepted. (Specimens in leaking or contaminated containers will not be processed by the Laboratory).  Unlabelled specimens, those not accompanied by a request form or with a form containing conflicting details will not be processed by the Laboratory.

3.6 Specimens must not be sent via the internal post system.

4. High Risk Specimens 4.1 In order to protect laboratory workers, specimens taken from patients known/suspected to have specific transmissible organisms must be labelled with a ‘High Risk’ sticker attached to both the specimen and the request card.

4.2 Specimens from patients/clients known/suspected to have the following infections must be marked as ‘High Risk’:

Hepatitis B Brucellosis Tuberculosis Hepatitis C Q- Fever Shigella HIV Psittacosis Typhoid Fever HTLV-1 Yellow Fever Typhoid Carriers

5. Collection of Specimens 5.1 The quality of the result of a laboratory investigation is directly related to the quality of the specimen sent.

5.2 All specimens must be collected in appropriate containers.

5.3 Patients/clients required to produce specimens for investigation must be provided with the appropriate container.

5.4 All specimens must be labelled correctly.

5.5 Accompanying request forms must be completed accurately. Additional relevant information must be provided e.g. foreign travel, drug therapy, water activities etc.

5.6 Where possible specimens must be collected at a time that will ensure specimen arrival in the Laboratory on the day of collection.

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5.7 Advice on the storage of specimens is outlined in the pathology hand book or can be obtained direct from the Laboratory (see Local Contacts, page 5)

5.8 Leakages or breakage of specimen containers must be dealt with following the guidance outlined in Community Infection Control Policy No.9: Spillages of Blood and/or Body Fluids, page 54.

6. Transportation of Specimens 6.1 Specimens must not be sent via the internal post system.

6.2 Specimens collected during Home Visits. 6.2.1 Specimens collected by healthcare workers during home visits must be transported in a rigid water proof box with a close fitting lid. Care must be taken to keep this container in an upright position during transportation.

6.2.2 All specimens must be in individual plastic transport bags prior to placement in this rigid water proof box.

6.2.3 Water proof boxes used for this purpose must be cleaned on a regular basis with hot water and general purpose detergent. Spillages or leakages must be dealt with immediately following the guidance outlined in Community Infection Control Policy No.9: Spillages of Blood and/or Body Fluids, page 66.

6.3 Using the Laboratory Courier Service 6.3.1 Specimens must be transported in designated secure transport boxes with fastenable lids.

6.3.2. All specimens must be in individual plastic transport bags prior to placement in transport boxes.

6.3.3 Each transport box must bear a warning label stating that the box must not be opened or tampered with, and a contact telephone number to be called in the event of the box being found unattended.

6.4 Specimens transported by Post 6.4.1 Advice must be sought from the Laboratory and the Royal Mail (or Mail contractor) prior to sending specimens via the postal service.

6.4.2 Advice on the nature of specimens permissible in the postal system as well as the type of packaging and labelling required must be ascertained prior to posting.

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Appendix 7

Guidelines for Cleaning the Propulse Ear Syringing Machine Community Infection Control Policy 2008 Planned Review November 2009

1. Cleaning and Disinfection of the Propulse Ear syringing machine 1.1 Prior to use:  The Propulse must be disinfected using a fresh 1000ppm hypochlorite solution. (See Community Infection Control Policy No.9: Management of Spillages and/or Body fluids, page 54) for information on the dilution of hypochlorite solutions.  Fill the water tank with hypochlorite solution.  Run the Propulse for a few seconds to allow the solution to fill the pump and flexible tubing.  Leave to stand for 10 minutes.  Empty the water tank.  Rinse the system through with tap water before use.  Dry the machine using disposable paper towels.

1.2 At the end of each patient/client’s ear syringing session:  Drain the water from the Propulse system.  Dry the Propulse machine with disposable paper towels.

1.3 At the end of the day/ ear syringing session:  The Propulse machine must be cleaned using the procedure described in 1.1.  Rinse the machine by running sterile water through and dry it prior to leaving it overnight.  Part used containers of sterile water must be discarded at the end of each working day.

2. Management of Accessories 2.1 Jet Tip Applicator  This item must be single use.  Dispose of immediately after use as healthcare waste.

2.2 Speculum for Otoscope (Auriscope)  This item must be single use.  Dispose of immediately after use as healthcare waste.

2.3 Jobson Horne Probe  This item must be single use.  Dispose of immediately after use as healthcare waste.

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3. Equipment Storage 3.1 All reusable equipment must be stored clean dry after use.

3.2 If a carry case is used to store equipment. Wipe down the inside of the case using general purpose detergent, warm water and a disposable cleaning cloth. Dry with disposable paper towels. Return the clean Propulse machine and equipment to the case.

Based on the Guidelines for Ear irrigation using the Propulse Electrical Syringe 2007, Primary Ear Care Centre, Rotherham. www.earcarecentre.com

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Appendix 8

Toys and Therapy Services Community Infection Control Policy 2008 Planned Review November 2009

1. Introduction 1.1 Toys are used in a variety of therapeutic interventions. The following guidance is intended to ensure that such toys do not act as vectors and/or carriers for infection.

1.2 Infection is just one risk associated with the use of toys in clinical/therapeutic practice and a full risk assessment must be conducted. Contact the Risk Management Team (See Local Contacts, page 5) for further guidance in this process.

2. Roles and Responsibilities 2.1 Staff  Have a responsibility to follow the guidance outlined in this document.  Have a responsibility to wear apporpriate protective clothing when involved in the cleaning of toys, sand and/or water trays (see Community Infection Control Policy No.3: Use of Protective Clothing, page 15).  Have a responsibility to carry out hand hygiene after handling used toys and/or removal of protective clothing (see Community Infection Control Policy No. 2: Hand Hygiene, page 9).  Have a responsibility to highlight any difficulties in the application of this guidance to their line manager.

2.2 Managers  Have a responsibility to ensure that staff are aware of (and apply) the guidance outlined in this document.  Have a responsibility to ensure that sufficient resources are available to allow the application of the guidance outlined in this document.  Have a responsibility to address deficiencies in the application of this guidance so as to prevent toys acting as a vector of infection.  Have a responsibility to identify most effective (in relation to cost and reduction of microbial contamination) in collaboration with the Community Infection Control Team.  Have a responsibility to ensure that decontamination of toys is considered prior to purchase.

3. Soft Toys 3.1 The use of toys soft toys must be avoided as they are difficult (and expensive) to clean effectively.

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3.2 Therapists who require the use of soft toys in clinical practice must encourage parents/carers to bring the child’s own soft toys to therapy sessions.

3.3 It may be possible to arrange a formal contract with a commercial laundry to launder and dry departmental soft toys. If such a contract is agreed soft toys must be laundered on a weekly basis. Soft toys that are “mouthed” and/or contaminated with body fluids (including saliva and nasal secretions) must be removed from use immediately and laundered.

4. Hard Toys 4.1 Hard toys must be cleaned on a regular basis (the frequency of cleaning will depend on the volume of use) with hot water and detergent. Disposable detergent wipes available from the NHS Logistics catalogue are also suitable for this purpose.

4.2 Hard toys that are “mouthed” and or become contaminated with blood/body fluids must be removed from use and cleaned immediately.

4.3 Hard toys that are contaminated with blood or body fluids (including saliva and nasal secretions) must be cleaned with a hypochlorite solution following the guidance outlined in Community Infection Control Policy No.9: Spillages of Blood and/or Body Fluids, page 66.

4.4 The cleaning of hard toys must be included in the cleaning schedule for each therapy room.

5. Play Mats 5.1 Play mats must be made of a durable material that will withstand daily cleaning with general purpose detergent and hot water.

5.2 Play mats must also be able to withstand cleaning with hypochlorite solutions (see Community Infection Control Policy No.9: Spillages of Blood and/or Body Fluids, page 54) in the event of contamination with blood and/or body fluids.

5.3 The cleaning of play mats must be included in the daily cleaning schedule for the room in which they are used.

6. Wet Play 6.1 If wet play trays are to be used these must be emptied and dried at the end of every session.

6.2 Toys used in the course of wet play must also be cleaned (see guidance in Section 4 of this Appendix, Hard Toys) and stored dry after every session.

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6.3 Before using wet play trays parents/carers must be asked if the child has experienced loose stool and/or vomiting in the previous 24 hours. Any child who has experienced these symptoms must not use the wet play area.

7. Sand Trays 7.1 If sand trays are to be used the sand must be changed on at least a weekly basis.

7.2 All toys used in the sand tray must also be cleaned (see guidance in Section 4 of this Appendix, Hard Toys) at this time.

7.3 If sand becomes wet and/or contaminated with blood/body fluids the sand must be discarded immediately.

7.4 Before using sand trays parents/carers must be asked if the child has experienced loose stool and/or vomiting in the previous 24 hours. Any child who has experienced these symptoms must not use sand trays.

8. Books 8.1 Books should be surfaced wiped with a damp cloth or detergent wipe on a weekly basis.

8.2 Books that are soiled or visibly marked should be discarded.

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Appendix 9

The Use of Bench Top Sterilisers Community Infection Control Policy Planned Review November 2009

1. Introduction 1.1 The use of a Sterile Service Provider is the most efficient method of sterilisation of equipment and maintenance of quality assurance protocols. Due to the complexities associated with the operation and maintenance of bench top sterilisers their use must be limited to those areas that cannot currently access a Sterile Services Provider.

1.2 The use of bench top sterilisers for reprocessing reusable equipment by provider and independent contractor services must be agreed by the Risk Management, Senior Management and Community Infection Control teams of each PCT following due consideration of alternatives.

1.3 The following guidance is intended to promote safe use of bench top sterilisers and all practitioners involved in their use must follow this guidance.

2. Roles & Responsibilities 2.1 Managers  Have a responsibility to inform new staff of this guidance on commencement of employment.  Have a responsibility to identify designated personnel as ‘Users’ of the bench top steriliser.  Have a responsibility to ensure that designated personnel are trained in the use of bench top sterilisers and receive regular updates.  Have a responsibility to ensure that sterilisers are subject to planned preventative maintenance.  Have a responsibility to ensure that procedures are in place and known to all users for dealing with malfunctions and/or accidents.  Have a responsibility to ensure that all bench top sterilisers are validated and installed correctly.  Have a responsibility to ensure that each bench top steriliser has a logbook in which yearly, quarterly, weekly and daily checks are recorded.  Have a responsibility to continue to work towards transference of sterilisation of reusable equipment to a Sterile Services Provider service.

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2.2 All staff Designated as ‘Users’ of bench top sterilisers. (HTM 2010 identifies the user as the person designated by management as responsible for the day- to day management of the steriliser).

 Have a responsibility to attend training on the use of bench top sterilisers.  Have a responsibility to ensure that the bench top steriliser is fit for use and is operated safely and efficiently.  Have a responsibility to ensure that weekly and daily checks as outlined in the following guidance are conducted and documented.  Have a responsibility to ensure that in the event of a failed cycle appropriate action is taken to correct the problem and that the load is re-sterilised before use.  Have a responsibility to ensure that the use of bench top sterilisers complies with the guidance outlined in this document.

3. Pre Cleaning of Equipment to be Sterilised 3.1 Pre cleaning is an essential part of the decontamination process. The sterilisation process will not be effective if the item is contaminated with organic matter. Pre-cleaning may be done either by machine (using an ultrasonic bath and/or a thermal washer disinfector) or manually. Best practice is to use an automated washing process.

3.2 Using an Ultrasonic Bath: 3.2.1 Ultrasonic cleaning baths are an effective way of cleaning intricate, jointed or serrated stainless steel and metal instruments. Ultrasonic baths must be used in accordance with the manufacturer’s guidance, in addition the following points must be considered:  Appropriate protective clothing must be worn (see Community Infection Control Policy No.3: Protective Clothing, page 15).  Hand hygiene (see Community Infection Control Policy No.2: Hand Hygiene, page 9) must be carried out after the removal of protective clothing.  Plastic items are not cleaned successfully by ultrasonic baths as they absorb the ultrasonic energy.  Gross contamination must be rinsed off by immersing instruments under warm water (do not rinse by running under tap as this creates an aerosol). Instruments must be opened and/or dismantled prior to placement in the basket.  A detergent solution must be used in ultrasonic baths in accordance with manufacturer’s guidance.  The detergent solution must be changed every 4 hours, more often if solution becomes heavily contaminated  On removal from ultrasonic baths, instruments must be rinsed by immersing in clean water (unless machine has an automatic rinse cycle). .

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 Drain and dry instruments. Inspect for residual debris. Repeat cleaning as necessary.  Ultrasonic baths must be emptied, cleaned and dried at the end of each session/day.  Ultrasonic baths must undergo regular testing:

Daily Automatic control test Remove and clean strainers and filters Weekly Check all safety devices Validation test to confirm ultrasonic action Quarterly and Checked by a qualified technician. Annually

3.3 Thermal Washer Disinfectors: 3.3.1 Small bench top versions are available. The size, model and type will depend on the needs of the practice/department taking into account: workload throughput, time requirements, and available space.

3.3.2 Washer disinfectors reduce the number of viable micro organisms contaminating devices but may not necessarily inactivate some viruses and bacterial spores, so instruments are not sterile after removal from the washer disinfector. Thermal washer disinfectors are required to operate to HTM2030 specification.

3.3.3 Please contact the Community Infection Control Team for further information on the use of thermal washer disinfectors in the pre cleaning of equipment prior to sterilisation.

3.4 Manual Pre Cleaning of Instruments prior to Sterilisation: 3.4.1 Instruments must be cleaned as soon as possible after use.

3.4.2 A dedicated deep sink must be used for pre-cleaning instruments.

3.4.3 Appropriate protective clothing (heavy duty gloves, plastic apron and eye protection) must be worn.

3.4.4 General purpose detergent and warm water is sufficient for pre cleaning. Instruments must be submerged whilst being pre cleaned and rinsed thoroughly. Care should be taken throughout the process to avoid splashing and/or the creation of aerosols.

3.4.5 Inspect instruments for residual debris or blood after pre cleaning and repeat if necessary.

3.4.6 Dry instruments with disposable paper towel prior to loading into the bench top steriliser.

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3.4.7 Hand hygiene must be carried out after removal of protective clothing (See Community Infection Control Policy No.2: Hand Hygiene, page 9).

4. Operation of Bench Top Sterilisers 4.1 Bench top sterilisers must be positioned so as to facilitate the movement of instruments from a ‘dirty’ to ‘clean’ area after sterilisation.

4.2 Bench top sterilisers must only be operated by designated ‘Users’ who have an understanding of the principles involved.

4.3 Instruments must be autoclaved at 134°c for a minimum of three minutes.

4.4 Displacement steam sterilisers are only suitable for unwrapped instruments and non-porous equipment. Pouches and sterilisation bags must not be used in displacement steam sterilisers.

4.5 Hollow instruments and/or those with lumen will not be effectively sterilised in a displacement steam steriliser.

4.6 Vacuum (forced air removal) bench top sterilisers can be used to process wrapped hollow and/or tubular equipment.

5. Maintenance of Bench Top Sterilisers 5.1 To ensure effective sterilisation the following checks and maintenance schedule must be followed.

5.2 Daily  The steriliser pressure, temperature and cycle time must be recorded daily and recorded in a dedicated logbook  The logbook must be kept next to the bench top steriliser and records retained for 11 years.  The User must record the time from start of cycle to the start of the sterilising phase, the length of the sterilising phase and the time to the end of the whole cycle.  Where the bench top steriliser is fitted with a printer these readings may be obtained from the printout.  It is the recommendation of the MHRA that all bench top sterilisers are fitted with a printer.  For each production cycle the User should note : if the steriliser controller indicated a passed or failed cycle; examine printouts from the steriliser to ensure that they are within prescribed limits; note the action taken if a failed cycle was indicated; note any fault or malfunction of the steriliser and action taken.  Prior to use, rinse all internal surfaces of the bench top steriliser with sterile water for irrigation, using a disposable cloth.  Fill the reservoir with sterile water for irrigation

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 At the end of the day/session drain the reservoir. Rinse all internal surfaces twice with sterile water for irrigation and dry with a disposable cloth. Record reservoir emptying in the logbook.  Part used containers of sterile water for irrigation must be discarded at the end of each working day.  Sterile water for irrigation must be used for validation, periodic and revalidation tests.

5.3 Weekly Testing & Maintenance (to be carried out in addition to daily checks).  Examine door seal and patency  Check security and performance of door safety devices

5.4 Quarterly and Yearly Test & Maintenance (to be carried out in addition to daily and weekly checks).  A qualified technician should carry out these tests and any maintenance. Copies of all engineer’s reports must be kept in the logbook.

5.5 Bench Top Vacuum Sterilisers  In addition to the above test and maintenance checks, a daily steam penetration test must be carried out in accordance with the manufacturer’s instructions.

6. Storage of Equipment after Sterilisation  Instruments must be stored dry and covered to protect them from dust.  Instruments which are required to be sterile at the time of use must be used within 3 hours of removal from the steriliser (placed onto, and covered by, a sterile field).

7. Purchase of Bench Top Sterilisers. 7.1 Prior to purchase of bench top sterilisers, consideration should be given to the use of disposables and/or Sterile Services Provider, both options have been shown to be the most efficient method of sterilisation and compliance with quality assurance protocols. 7.2 If you are considering the purchase of vacuum (forced air removal) bench top steriliser that will process wrapped hollow tubular equipment, ensure that a validated daily steam penetration test is available for the steriliser.

8. Supporting Literature British Dental Association.2003. A12 Advice Sheet. Infection Control in Dentistry. February. Department of Health.2007. Decontamination of reusable medical devices in the primary, secondary and tertiary care sectors (NHS& Independent Providers) 2007 Clarification and Policy Summary. Department of Health.2000. Decontamination of Medical Devices. HSC 2000/031 Department of Health.1997. Health Technical Memorandum 2030 Washer - Disinfectors. Operational management. NHS Estates. Department of Health.1997. Health Technical Memorandum 2031. Clean steam for sterilisation. NHS Estates.

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Department of Health.1994. Health Technical Memorandum 2010. Sterilization. Part 1: Management Policy and Part 4: Operational Management. HMSO. London. Hospital Infection Society.1998 Sterilisation, Disinfection and Cleaning of Medical Equipment: Guidance on decontamination from the Microbiology Advisory Committee to the Department of Health (The MAC manual). Medicines & Healthcare Regulatory Agency.2006. Decontamination and Infection Control. Medicines & Healthcare Regulatory Agency.2002. MDA DB 2002 (06) Bench top sterilisers – guidance on purchase, operation and maintenance. NHS Estates.2003. A Guide to the Decontamination of Reusable Surgical Instruments.

Further literature on the use of bench top sterilisers and the decontamination of equipment is available from the Community Infection Control Team.

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Appendix 10

Notification of Infectious Diseases Community Infection Control Policy 2008 Planned Review November 2009

1. Introduction The registered medical practitioner attending the patient/client and making the diagnosis is responsible for the notification of infectious disease to the North East and North Central London Health Protection Unit (HPU). This will allow for a timely public health assessment and necessary action to prevent secondary cases.

2. Notifiable Diseases in England and Wales are:

Acute encephalitis Meningitis (meningococcal, Tetanus pneumococcal, haemophilus influenzae, viral, other) Acute poliomyelitis Meningococcal Septicaemia Tuberculosis (without meningitis) Anthrax Mumps Typhoid Fever Cholera Ophthalmia Neonatorum Typhus Diphtheria Paratyphoid fever Viral haemorrhagic fever Dysentery Plague Viral hepatitis (A,B, C, other) Food Poisoning Rabies Whooping Cough Leprosy Relapsing Fever Yellow Fever Leptospirosis (Weil’s Disease) Rubella Malaria Scarlet Fever Measles Smallpox

2.1 Not all infectious diseases/environmental hazards are statutorily notifiable but may potentially have an impact on the general population. Therefore any infection or incident which is assessed to potentially have an impact on the health of the public health i.e chemical incident, a serious untoward incident due to a health protection issue, must also be reported to the HPU.

2.2 A guide on the expected time frame of notification and the rationale are detailed in the table below.

2.3 Contact the Reactive Team, North East & North Central London HPU on 020 7759 2860 or the Out of Hours Health Protection Team on 07623 541417 (evenings, weekends and bank holidays).

2.4 Notification forms can be obtained from the Infectious Diseases Clerks in each Borough (see Local Contacts, page 5).

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Notification of Communicable Diseases This table outlines the suggested communication procedures and rationale between City and Hackney PCT, Newham PCT and Tower Hamlets PCT and the North East and North Central London Health Protection Unit (HPU) on clinical suspicion or microbiological confirmation of certain communicable diseases. This list is not exhaustive if any doubt, please telephone, the HPU on 020 7759 2860. Please also inform the Infection Control Team and refer to relevant infection control policy (on the intranet).

Conditions Clinical suspicion Mode of Recommended EHO and HPU and other actions and/or Communication with time frame in microbiology HPU which to notify findings Common Campylobacter, Notification sent direct to Routine EHOs contact patients and take action dependent on risk gastro- Shigella sonnei, environmental health status intestinal Salmonella, Giardia officers using the If we are informed first we attempt to identify whether cases pathogens Notification Book are in risk groups before passing to EHOs Shigella – non- Phone call to HPU Immediate The non-sonnei shigellas are now considered to present a sonnei greater public health risk and are investigated and dealt with as for typhi. Less usual Cryptosporidium, Phone call to HPU Same day HPU investigate source and risk of outbreak gastrointestinal amoebic dysentery pathogens More serious S typhi and Phone call to HPU Immediate HPU investigate source and risk of outbreak – including gastro- paratyphi, E coli exclusions and microbiological clearance where needed for intestinal 0157, Cholera, cases and contacts pathogens typhus and others Reports from TB – fully sensitive Notify the TB Team at Routine We assume that positive cases are being treated by the the Chest HUH on ext 7775 or chest clinics and registered on London TB register. No Clinics 7542 involvement unless there is a wider public health risk (e.g. schools/ hospital exposure) TB – multiple Notify the TB Team at Immediate Discussion between HPU and Chest clinics resistant the HUH as above

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Conditions Clinical suspicion Mode of Recommended EHO and HPU and other actions and/or Communication with time frame in microbiology HPU which to notify findings Other C. diphtheriae Phone call only if clinical Immediate Major investigation and disease control required bacteriology suspicion of Diphtheria or toxigenic strain confirmed Pertussis Phone call to HPU Immediate Antibiotic prescription to family if susceptible cases Meningococcal Phone call to HPU immediate Antibiotic prophylaxis to susceptible contacts, vaccination for meningitis, vaccine preventable cases septicaemia, and other pathogenic cases (e.g. eye swabs) and Hib Meningitis Phone call to HPU Immediate Reassure contacts and advise chemoprophylaxis and (pneumococcal, vaccination where appropriate. haemophilus influenza, viral) INVASIVE Group A Phone call to HPU Immediate Assessment and information for household contacts. Strep Scarlet Fever Phone call to HPU Same day Ensure antibiotics and exclusion advised. Outbreaks Any organisms Phone call to HPU Immediate Combined actions Hepatitis Acute Hepatitis A or Phone call to HPU Immediate HPU and EHO investigate source, risk of outbreak, and Hepatitis E immunisation to contacts for Hep A. Acute Hepatitis B Phone call to HPU Immediate HPU investigates source and contact immunisation Presumed Chronic By post to HPU routine HPU investigates source and contact immunisation Hep B Hepatitis C Phone call to HPU Same day Enhanced surveillance by HPU

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Conditions Clinical suspicion Mode of Recommended EHO and HPU and other actions and/or Communication with time frame in microbiology HPU which to notify findings Other viruses Mumps Phone clinical suspicion Same day Immunisation of institutions during outbreaks. during outbreaks (not Advice to contacts serology) Measles Phone clinical suspicion Immediate Risk assessment, advice of immunisation of institutions and during outbreaks contacts Influenza (SARS, Phone call Immediate Risk assessment and facilitation of screening in line with Avian Influenza) national guidance. Rubella Phone call Immediate Risk assessment to identify at risk contacts and organise appropriate action. Other E.g. Acute Phone call to HPU Immediate As required on case by case basis unusual encephalitis, Acute disease or Polio, , Leprosy, modifiable Leptospirosis, disease Malaria Ophthalmia Neonatorum, Rabies, Relapsing Fever, Smallpox, , Viral haemorrhagic fever and Yellow Fever Suspected E.g. Norovirus and Phone call to HPU Immediate Investigation and infection control Outbreaks in other non-specified schools including scabies

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