Standard Infection Control Precautions - Black Country Partnership [PDF]

Infection Prevention and Control Assurance - Standard Operating Procedure 1 (IPC SOP 1)

Standard Infection Control Precautions Why we have a procedure? Adherence to this procedure will ensure that Black Country Partnership Foundation Trust staff are protected as far as is reasonably practicable when providing care to patients with a known or suspected infection or when there is anticipated contact with patient’s blood or other bodily fluids. It will also ensure compliance with the Health and Social Care Act 2008: Code of Practice for the NHS for the Prevention and Control of Healthcare Associated Infections (revised January 2015). This document has been developed to provide a framework to provide staff with clear guidelines on basic infection prevention and control precautions.

What overarching policy the procedure links to? 

This procedure is supported by the Infection Prevention and Control Assurance Policy

Which services of the trust does this apply to? Where is it in operation? Group Mental Health Services Learning Disabilities Services Children and Young People Services

Inpatients   

Community   

Locations all all all

Who does the procedure apply to? All staff involved in the care of patients should adhere to these standard procedures when dealing with a known or suspected outbreak of infection/ communicable disease or anticipate contact with blood or other bodily fluids e.g.  Matrons, Service Managers, Ward Managers and all clinicians involved in the delivery of care  Facilities staff All staff have a responsibility for ensuring that the principles outlined within this document are universally applied.

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When should the procedure be applied? 

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Standard Infection Control Precautions (SICPs), are intended for use by all staff, in all care settings at all times for all individuals whether infection is known to be present or not, to ensure the safety of those being cared for and staff and visitors in the care environment The application of SICPs during care delivery is determined by the assessment of risk and includes the task/level of interaction and/or the anticipated level of exposure to blood or other body fluids There are ten elements which make up standard infection control precautions (SICPs) and are described below

Definitions Standard Infection Control Precautions (SICPs)

SICPs are the basic infection prevention and control measures necessary to reduce the risk of transmission of micro-organisms from recognised and unrecognised sources of infection. These sources of (potential) infection include blood and other body fluids secretions or excretions (excluding sweat), non-intact skin or mucous membranes and any equipment or items in the care environment that are likely to become contaminated

Aerosol Generating Procedure

Procedure performed on patients that are more likely to generate higher concentrations of respiratory aerosols than coughing, sneezing, talking, or breathing, presenting healthcare personnel with an increased risk of exposure to infectious agents present in the aerosol e.g. suctioning

How to carry out this procedure Additional Information/ Associated Documents  Infection Prevention and Control Assurance Policy  Waste Management Policy and SOPs  Hand Hygiene Policy  Medical Devices Policy and SOPs  Infection Prevention and Control Assurance - Standard Operating Procedure 8 (IPC SOP 8) - Sharps and Blood/Body Fluid Contamination Injury – Immediate Actions Patient Placement The potential for transmission of infection or infectious agents should be assessed at the patient’s entry to the care area and should be continuously reviewed throughout the stay, this should influence placement decisions in accordance with clinical need.

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Staff should:  As part of the initial patient assessment complete the Infection Risk Assessment and document findings on the risk assessment tool. Patients with a score above 6 the staff must contact the infection prevention and control team for advice on placement and management  Avoid unnecessary movement of patients between care areas  Patients who may present an infection risk e.g. diarrhoea, vomiting, and unexplained rash, flu-like symptoms etc. must be assessed and placed in a suitable environment to minimise cross-transmission e.g. isolated in a single room with a clinical wash-hand basin or cohort area Example of the Infection Risk Assessment tool (located in the patient assessment booklet):

Hand Hygiene Hand hygiene is considered to be the single most important practice in reducing the transmission of infectious agents, including Healthcare Associated Infections (HCAI), when providing care. Before performing hand hygiene:  Expose forearms  Remove all hand/wrist jewellery (a single, plain metal finger ring is permitted but should be removed (or moved up/down) during hand hygiene)  Ensure finger nails are clean, short and that artificial nails or nail products are not worn; and  Cover all cuts or abrasions with a waterproof dressing Hand hygiene should be performed:  Before touching a patient Standard Infection Control Precautions

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Before clean/aseptic procedures After body fluid exposure risk After touching a patient; and After touching a patient’s immediate surroundings

N.B. please refer to the Hand Hygiene policy

Respiratory Hygiene Respiratory hygiene and cough etiquette is designed to contain respiratory secretions to prevent transmission of respiratory infections such as colds and influenza: Staff should encourage patients to:  Cover the nose and mouth with a disposable tissue when sneezing, coughing, or wiping and blowing the nose  Dispose of all used tissues promptly into a waste bin after use  Wash hands with non-antimicrobial liquid soap and warm water after coughing, sneezing, using tissues, or after contact with respiratory secretions or objects contaminated by these secretions  Keep contaminated hands away from the mucous membranes of the eyes and nose; and  Cough/ sneeze into the inner elbow if tissues are not immediately available to hand also known as “sneeze into your sleeve” Staff should promote respiratory hygiene and cough etiquette to all individuals and help those (e.g. elderly, children) who need assistance with containment of respiratory secretions e.g. those who are immobile will need a supply of tissues and receptacle (e.g. disposal bag) readily at hand for the prompt disposal of used tissues and offered/assisted with hand hygiene/ decontamination. Personal Protective Equipment (PPE) The type of PPE used must provide adequate protection to staff against the risks associated with the procedure or task being undertaken. PPE should be removed as soon as is practicable, once the procedure is completed; and always changed between patients or different tasks on the same patient. All PPE should be:  Located close to the point of use, the use of wall mounted PPE dispensers are recommended (if safe within the patient environment)  Stored to prevent contamination or deterioration in quality (check manufacturer’s instructions) in a clean/ dry area until required for use  Expiry dates must be adhered to  Reusable items, e.g. non-disposable goggles/face shields/visors must have a decontamination schedule with responsibility assigned and must always decontaminated immediately after each use

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General Guidance GLOVES

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APRONS

Worn when exposure to blood and/or other body fluids is  anticipated/likely. Changed immediately after each patient and/or following completion of a clinical procedure or task. Changed if a perforation or puncture is suspected  Be appropriate for use, fit for purpose and well-fitting to avoid excessive sweating and interference with dexterity Gloves must be worn when using cleaning products Single use and disposable, latex and powder free e.g. nitrile gloves GOGGLES/VISORS

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Worn if blood and/or body fluid contamination to the eyes/face is anticipated/likely (always during Aerosol Generating Procedures (AGPs). Regular corrective /prescription spectacles are not adequate eye protection

GOWNS (long sleeved)

Worn to protect uniform or clothes when contamination is anticipated/likely e.g. when in direct care contact with a patient or contaminated items, waste, laundry or cleaning etc. Aprons must be changed between patients and/or following completion of a procedure or task

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SURGICAL FACE MASKS (fluid repellent)

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Worn when there is a risk of extensive splashing of blood and/or other body fluids e.g. in the event of a large body fluid spillage, treating patients with scabies; and changed between patients and immediately after completion of a procedure

FFP3 RESPIRATOR MASKS

worn if splashing or spraying of blood, body fluids, secretions or excretions onto the respiratory mucosa is anticipated/likely  well-fitting and fit for purpose (fully covering the mouth and nose)  manufacturers’ instructions must be adhered to ensure the most appropriate fit/protection;  removed or changed: - at the end of a procedure/task - if the integrity of the mask is breached, e.g. from moisture build up after extended use or from gross contamination with blood or body fluids; and in accordance with manufacturers’ instructions

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Are only to be worn following advice from Infection Prevention and Control Team FFP3 face masks must only be used for specific situations. Wearers need to be fit tested to ensure the face masks fit the face and offer maximum protection. NB fit testing can only be undertaken by specially trained personnel (contact infection Prevention and Control for details)

NB: All PPE used for patient care delivery must be disposed of correctly as clinical waste Standard Infection Control Precautions

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Footwear must be:  Non-slip, clean and well maintained, and  Support and cover the entire foot to avoid contamination with blood or other body fluids or potential injury from sharps The Correct Sequence for Donning (Applying) PPE

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The Correct Sequence for Removing PPE

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Management of Care Equipment Care equipment can become contaminated with blood, other body fluids, secretions and excretions and transfer infectious agents during the delivery of care. Care equipment is classified as either: Single Use Single Patient Use Used once then discarded. The packaging carries this symbol:

For use only on the same patient this applies to oral syringes. Oral syringes must be labelled with patient initials and date decontaminated and discarded in adherence with the manufacturers’ instructions

Reusable (non-invasive equipment) Often referred to as communal equipment reused on more than one patient. MUST be decontaminated between each use e.g. commode.

The Manufacturers’ guidance must be adhered to for use and decontamination of all care equipment and the guidance must be retained in the clinical area for reference. (Additional information is also available in the Management of Medical Devices Policy). Decontamination of reusable non-invasive care equipment must be undertaken:  Between each use  After blood or body fluid or other visible contamination  At regular predefined intervals as part of an equipment cleaning protocol  Before disinfection; and  Before inspection, servicing or repair Cleaning schedules must be held within the clinical area documenting all re-useable equipment in the area and must include responsibility for; frequency of; and method (including appropriate cleaning solutions/disinfectants) of equipment decontamination. The use of signature sheets and application of green ‘I am clean tape’ is required. It is the responsibility of the person in charge to ensure that the care area is safe for practice and this includes environmental cleanliness/maintenance. The person in charge has the authority to act if this is deficient, by reporting any issues to the Estates and Facilities help desk immediately. If issues are not rectified within a reasonable time timeframe then the issue will need to be escalated into management chain and a DATIX incident report completed. The care environment must be:  Free from clutter to facilitate effective cleaning, well maintained and in a good state of repair; and be  Clean and routinely cleaned in accordance with the NHS National Cleaning Standards for England  Domestic cleaning schedules must be displayed in all clinical areas

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For routine cleaning by facilities staff a fresh solution of surfactant cleaner in warm water is recommended for routine cleaning (diluted as per manufactures instructions). This should be changed when dirty, at 15 minutes intervals or when changing tasks. For routine cleaning by nursing/clinical staff detergent or disinfection wipes can be used, following the manufacturers’ instructions. Disinfection of the environment is not required routinely; however a solution of 1,000ppm available chlorine should be used routinely on sanitary fittings. Staff groups should be aware of their environmental cleaning schedules and clear on their specific individual responsibilities. Cleaning protocols should include responsibility for cleaning; frequency of cleaning; and method of environment decontamination. Items must be cleaned in line with the manufacturers’ instructions to ensure items are not damaged by cleaning products. Cleaning and Maintenance of the Environment It is the responsibility of the person in charge to ensure that the care area is safe for practice and this includes environmental cleanliness/maintenance. The person in charge has the authority to act if this is deficient, by reporting any issues to the Estates and Facilities help desk immediately. If issues are not rectified within a reasonable time timeframe then the issue will need to be escalated into management chain and a DATIX incident report completed. The care environment must be:  Free from clutter to facilitate effective cleaning, well maintained and in a good state of repair; and be  Clean and routinely cleaned in accordance with the NHS National Cleaning Standards for England  Domestic cleaning schedules must be displayed in all clinical areas For routine cleaning by facilities staff a fresh solution of surfactant cleaner in warm water is recommended for routine cleaning (diluted as per manufactures instructions). This should be changed when dirty, at 15 minutes intervals or when changing tasks. For routine cleaning by nursing/clinical staff detergent or disinfection wipes can be used, following the manufacturers’ instructions. Disinfection of the environment is not required routinely; however a solution of 1,000ppm available chlorine should be used routinely on sanitary fittings. Staff groups should be aware of their environmental cleaning schedules and clear on their specific individual responsibilities. Cleaning protocols should include responsibility for cleaning; frequency of cleaning; and method of environment decontamination. Items must be cleaned in line with the manufacturers’ instructions to ensure items are not damaged by cleaning products.

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Safe Management of Linen The laundry service for the trust is provided by an external company who provide towels, sheets, blankets, pillow cases and laundry bags, these items are washed at a central laundry facility. General Principles – All Types of Linen  All used linen must be placed in an appropriate colour coded bag as detailed in this procedure  Used linen must always be bagged at the bedside never carried through the ward to the sluice/dirty utility room or laundry.  Skip/laundry bags must never be more than 2/3 full  Used linen handling must conform to the specifications of CfPP 01-04 as outlined in this procedure  Staff must ensure they wear personal protective equipment when dealing with used linen  Staff must always wash their hands after dealing with used linen and/ or after removing personal protective equipment  Staff must ensure that items such as needles, syringes, instruments and other foreign objects are not placed in laundry bags  No purchase of washing machines will take place without formal agreement by the Infection Prevention and Control Team and Facilities Management Team  Only linen items that withstand the intensive laundry process may be purchased  All dirty linen must be sent to the external contractor for laundering as per the contract  All Trust owned items of linen, including curtains, must be clearly labelled  Breaches to this procedure must be recorded and communicated via the Incident Reporting process (DATIX)

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Categories of Used/ Soiled Linen: Category of Linen

Colour of Bag

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Clean Linen  

All used linen other than that listed below falls within this category must be placed within a white plastic laundry bag.  Other than Curtains RTS (return to sender, Trust own items) and Rejected items. Bags containing used laundry must be stored in a secure area, away from public access whilst awaiting collection  NB: Manual soaking/ washing of soiled items must never be carried out  A sluice cycle or cold pre-wash must be used for all soiled items

Soiled or Fouled Linen

Infectious or Heavily Soiled Linen

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Standard Infection Control Precautions

Any linen that has not been used since it was last laundered Clean linen must be in a good state of repair, as tearing or roughness can damage the patient’s skin The condition of linen in use should be monitored by the laundry contractor and by all staff NB: If linen is taken into an isolation room and not used, the linen must be treated as infected and laundered prior to further use as it may be potentially contaminated by the environment

This is any used linen which is soiled with blood or any other body fluid; and all linen used by a patient even with a known infection All soiled / infected linen must be placed in a soluble alginate (RED) bag, inside the correct laundry bag The soluble bag must be placed directly into the washing machine to minimise contact and prevent transmission of infection to laundry staff or contamination of the environment The outer plastic bag should be disposed of as clinical waste

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Clean linen must be stored in a clean, appropriately maintained designated area, preferably an enclosed cupboard. If clean linen is not stored in a cupboard then the trolley used for storage must be designated for this purpose and completely covered with an impervious covering that is able to withstand cleaning and/or disinfection. Clean linen should be kept in the outer packaging until required – (packaging should not be removed for storage unless it is visibly soiled). For all used linen (often referred to as soiled linen):  Ensure a laundry receptacle is available as close as possible to the point of use for immediate linen deposit. A disposable white plastic linen bag is used for this purpose Do not:  Rinse, shake or sort linen on removal from beds  Place used linen on the floor or any other surfaces e.g. a chair/table top  Re-handle used linen once bagged, or overfill laundry receptacles For all foul/infectious linen i.e. linen that has been used by a patient who is known or suspected to be infectious and/or linen that is contaminated with blood or other body fluids e.g. faeces:  Place directly into a pink water-soluble/ alginate bag and secure; then place into a red (or white) coloured linen bag and secure before placing in a laundry receptacle, or  If the item(s) is grossly soiled and unlikely to be fit for reuse following laundering then dispose of as healthcare waste (note for patient’s own clothing, permission will need to be sought). The Facilities Helpdesk should be informed if hospital linen is discarded  Store all used/infectious linen in a designated, safe, lockable area whilst awaiting collection. Uplift schedules from used/infectious linen areas must be acceptable to the care area and there should be no build-up of linen receptacles/bags Categories of Soiled Linens Normal soiled used linen - this accounts for the majority of all used linen and can be dealt with by:  Being bagged into the approved white plastic/blue linen laundry bags  Where it is to be washed within the unit, it should be placed into a dedicated container whilst waiting processing (e.g. a laundry basket) Heavily Soiled / Infected / Infested Linen - this is linen has been soiled by faeces, blood or other bodily fluid and should include linen from all cases of diarrhoea of unknown origin. It also includes linen from any patient identified with infection/ infestation. All soiled /infected linen must be placed in a red soluble alginate bag, inside a plastic (or linen) laundry bag. The red/pink soluble laundry bag can be placed directly into the washing machine to minimise contact and prevent transmission of infection to laundry staff or contamination of the environment. There are two varieties of soluble bag available:  One which is for use in commercial laundries where water temperatures are very high – fully dissolvable Standard Infection Control Precautions

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One for use in domestic style washing machines – dissolving seam Ordering codes are available on the infection prevention and control website

Storage and Collection of Used Laundry - Full used laundry bags should be stored awaiting collection in a locked area and should be removed from the ward at least daily. Laundering processes  Flat Linen (e.g. bed linen, towels, hospital pyjamas etc.) - Laundering of hospital flat linen should be carried out by a laundry contractor. The Infection Prevention and Control Team must be consulted on the negotiation of any contract/ specification for laundry services. Laundries chosen must comply with the requirements of DoH Choice Framework for Local Policy and Procedures 01-04 – Decontamination of linen for health and social care: Guidance for linen processors implementing BS EN 14065. Compliance should be assured through a site visit  Patients Personal Linen - All personal items of clothing which cannot be taken home by visitors/relatives, should be laundered on site  Soiled/ infected /infested personal items should be bagged as above before being transported to the laundry room. Each person’s items should be bagged and washed separately on the appropriate cycle  Manual soaking or sluicing of items in bowls or sinks must NEVER be allowed. This practice causes build-up of organisms in warm stagnant water and then rubbing or ringing causes splatter to the surrounding areas, spreading organisms around. If necessary use the pre wash cycle on the washing machine  Always follow the machines user instructions  Heat resistant items should be washed in the hottest cycle available for the item  A cycle which reaches 71◦C for not less than 3mins or 65◦C for 10 mins.  Heat labile (sensitive) items should be washed in the hottest cycle possible for the fabric  Laundry washed by patients as part of therapy - It is essential that when patients are being encouraged to wash their own clothing as part of therapy that the principles of infection prevention and control are also taught. This is part of health education but also ensures that daily contact with, and facilities used by other patients don’t expose them to infection risk. Patients should be encouraged to; avoid soaking items before washing, avoid contamination of appliances by soiled items, and to wash their hands following handling their soiled laundry. 

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Laundry taken home by Relatives/ Carers - If soiled items are taken home by relatives for laundering, no pre-washing or soaking of the item must take place in the clinical area. Wherever possible, used linen should be wrapped in a plastic bag (not yellow/orange clinical waste bags). If alginate bags are used, they must be the type with the dissolvable seam as fully soluble bags may cause blockage in domestic machines. Staff Uniforms - Uniforms of clinical staff should be changed daily. If uniforms or personal clothing of staff becomes soiled with blood or bodily fluids they should be changed immediately, ideally staff should be wearing disposable aprons for tasks where exposure to bodily fluids is anticipated. If a uniform is contaminated in this manner then the potential to wash it on-site should be sought, if this is

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not possible it should be placed into an alginate bag (with a seam) and taken home to wash on the hottest setting for the fabric. It is current Trust policy for staff to launder uniforms at home and it is recommended that this is done separately to other household laundry at the hottest temperature for the fabric. (The RCN says nurses who wash uniform at home are eligible to claim tax relief. See Uniform Policy) Management of Blood and Body Fluid Spillages Spillages of blood and other body fluids are considered hazardous and must be dealt with immediately by staff trained to undertake this safely. Responsibilities for the cleaning of blood and body fluid spillages should be clear within each area/care setting following the procedure below:

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Safe Disposal of Waste “Health Technical Memorandum 07-01: Safe management of healthcare waste” contains the regulatory waste management guidance for the NHS in England including waste classification, segregation, storage, packaging, transport, treatment and disposal. Full information on segregation and disposal of waste can be found in the Waste Management Policy

Where do I go for further advice or information?   

Infection Prevention and Control Team Your Service Manager, Matron, General Manager, Head of Nursing, Group Director Your Group Governance Staff

Training Staff may receive training in relation to this procedure, where it is identified in their appraisal as part of the specific development needs for their role and responsibilities. Please refer to the Trust’s Mandatory and Risk Management Training Needs Analysis for further details on training requirements, target audiences and update frequencies. Monitoring / Review of this Procedure In the event of planned change in the process(es) described within this document or an incident involving the described process(es) within the review cycle, this SOP will be reviewed and revised as necessary to maintain its accuracy and effectiveness. Equality Impact Assessment Please refer to overarching policy Data Protection Act and Freedom of Information Act Please refer to overarching policy

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Standard Operating Procedure Details Unique Identifier for this SOP is

BCPFT-COI-POL-05-01

State if SOP is New or Revised

New

Policy Category

Control of Infection

Executive Director whose portfolio this SOP comes under Policy Lead/Author Job titles only Committee/Group Responsible for Approval of this SOP

Executive Director of Nursing, AHPs and Governance Infection Prevention and Control Team Infection Prevention and Control Committee

Month/year consultation process completed

November 2015

Month/year SOP was approved

December 2015

Next review due

December 2018

Disclosure Status

‘B’ can be disclosed to patients and the public

Review and Amendment History Version

Date

Description of Change

1.0

Dec 2015

New Procedure established to supplement Infection Control Assurance Policy

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