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INFECTION CONTROL
Care is increasingly being delivered in a wide range of settings, from care homes, residential homes, community settings and hospitals. The control of Infection is an important and integral part of health and social care. Infection Control policies are in place in all care settings and Aberness Recruitment Agency has a duty to ensure all our staff have guidelines in place for the Control of Infection.
Infection control is the name given to a wide range of procedures and techniques intended to prevent the spread of infection. All people working within or receiving a service are at risk of spreading infection, especially if they come into contact with blood or bodily fluids such as urine, faeces, sputum etc. Such bodily fluids may contain infections that can spread if adequate precautions are not taken.
Adherence to strict guidelines on infection control is of paramount importance in ensuring the safety of Service users, staff and Clients.
This policy applies to all employees within Aberness Recruitment Agency. Line managers are responsible for the implementation of the policy by ensuring staff have sufficient training and knowledge to implement safe working practises. All staff are required to take individual responsibility to reduce the spread of infection by:

Abiding by Aberness Recruitment Infection Control Policy and any training or instructions received

At all times, observe high standards of hygiene to protect themselves and their Service users from unnecessary spread of infection

All staff are personally accountable for their actions and responsible for ensuring that they comply with Infection Control policies within Aberness
Recruitment and Client’s.
The aim of this policy is to reduce the incidence of infection to Service users, staff and care establishments. Preventing the spread of infection will help reduce:

Staff and service user infections
 Worsening of a Service user’s condition

Avoidable admissions to hospital

Spread of infections to other care establishments

Staff absence

Costly interventions
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INFECTION CONTROL
In order to ensure, so far as is reasonable practicable, the prevention and control of infection, Aberness Recruitment will give high priority to ensuring that the level of information which is provided to staff is appropriate to their roles and responsibilities of the post to which they are employed. Aberness Recruitment is committed to make available resources to support the training requirements of all employees in the prevention and control of infection.
All staff are required to complete E-Learning on Infection control within first 3 months of employment and annually thereafter.
Line managers must ensure that all staff are aware of the contents of this policy and its implications for their practise, this is discussed at indication. Staff have supervisions every 3 months, which includes infection control. The training needs of all staff is identified as part of their annual appraisal.
There are six elements in the cycle of infection, and all six must be present before the transmission of infection can take place.
Element in the cycle of infection
1. Infectious
Agent
Explanation
When germs enter the body, they can cause illness
2. Reservoir Where germs normally live and multiply
Common examples



Bacteria, virus, fungi, protozoa
Humans
Contaminated food, water, toys, sports equipment
 Insects, animals, soil
3. Portal of
Exit
How germs leave the body  Respiratory tract
 Intestinal tract
 Urinary/genitourinary tract
 Open wounds
 Blood and body fluids
4.
Transmission
How germs are spread  Direct physical contact
 Respiratory droplet
 Stool (faecal-oral route)


Contact with blood/body fluids
 Indirect contact
Needle stick injury
 Ingestion of contaminated food and water
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INFECTION CONTROL
5. Portal of
Entry
6.
Susceptible
Host
How germs enter the body
A person who gets an infection because he/she is unable to successfully fight the infection
 Contaminated dust particles
 Contaminated objects
 Insects/animals


Respiratory tract


Intestinal tract
 Urinary/genitourinary tract
Open wounds
Mucus membrane, e.g. eye, mouth
 Infants, elderly and debilitated.
 Persons who are ill.
 Children who are not fully immunized or have
 underdeveloped immune systems.
Persons taking certain drugs
 that lower their defences against germs.
Persons with underlying disease conditions that lower their defences against other germs.
Breaking the cycle of infection by targeting one or more links can halt the spread of infection. This usually involves:

Eradicating the source of infection through appropriate antimicrobial therapy

Preventing the method of spread through hand washing, hygiene, disposal of waste, decontamination of equipment

Protecting the individual at risk by immunisation

Preventing microbes from entering the body by wearing protective clothing, using aseptic technique, covering wounds etc.
It is impossible to identify everyone who is infectious. Some diseases are infectious before any signs develop e.g. chickenpox and some may not show signs and symptoms e.g. hepatitis B. Some people may be carriers without developing the infection e.g. salmonella or MRSA. For this reason it is important that everyone carries out infections control precautions at all times, regardless of whether infection is present or suspected.
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INFECTION CONTROL
Adherence to good practise in relation to infection prevention and control has been shown to reduce the risk of infection to service users and staff. Universal infection control precautions are designed to reduce the risk of cross infection from both recognised and unrecognised sources of infection and should be applied at all times by all care staff. These include the following:

Hand hygiene

Use of Personal Protective Equipment

Safe Handling and Disposal of Sharps

Disposal of Waste

Laundry

Aseptic Technique

Use and Care of Invasive Devices

Management of Inoculation Injuries

Pathology Specimens
Hand hygiene is the most important method of preventing infection and cross infection. The purpose of hand hygiene is to remove or destroy any bacteria picked up on hands (transient bacteria). In some situations e.g. prior to invasive procedures, it is necessary to also reduce the numbers of bacteria that normally live on the skin (resident bacteria). This prevents the bacteria being transferred to other people, while at the same time protecting yourself. A good hand washing technique is more important that the kind of product you use.
Hand washing must be carried out using running water at a comfortable temperature. Clinical hand washbasins should be provided wherever clinical care is given. A clinical hand washbasin consist of lever operated mixer taps with no plug and no overflow. If mixer taps are not available, a thermal control should be added to the hot tap to provide warm running water.
Liquid soap should be used for hand washing. This should be provided in wallmounted dispensers with disposable cartridges or disposable pump action bottles. Dispensers should be kept clean and replenished.
Alcohol hand rubs may also be used. They are particularly useful in situations where hand washing may not be convenient.
Hand creams may be used to help protect hands from soreness and supplied again as a pump-action container.
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INFECTION CONTROL
Disposable paper towels must also be available at all hand wash basins in clinical settings, including toilets and kitchens. Communal towels are not acceptable.
Foot operated bins must be used for disposal of paper towels. Do not use hands to raise the lid.
Routine Hand Hygiene is to remove dirt and most transient micro-organisms found on the hands. Hands must be washed:

Before starting work and going home

After contact with body fluids e.g. assisting service users with personal hygiene

Before and after giving care

Before and after wound management

Before putting on and after removing personal protective equipment

After using the toilet, blowing your nose or covering a sneeze

Before eating and handling preparing food

After handling pets

After handling raw food

After handling refuse and clinical waste

When hands look or feel dirty

After cleaning activities

Before and after smoking
Before starting work, wash any broken or cut areas of exposed skin and cover with a waterproof dressing. Jewellery and wristwatches should be removed prior to work. Fingernails should be short, clean and free from nail polish, please refer to Dress Code Policy. The technique of hand hygiene is more important than the solution used:
I. Remove hand and wrist jewellery and wristwatches and roll up sleeves,
(please refer to Dress Code Policy as such items should not be worn at work). Wedding rings without stones may be left in place.
II. Wet hands under warm running water
III. Apply liquid soap
IV. Rub this into all parts of the hands vigorously, without applying more water, using the 6-step technique (see table) for at least 10 – 15 seconds
V. Rinse hands thoroughly under running water
VI. Dry thoroughly using paper towels
If hands are clean, apply 5mls of alcohol rub/gel, rubbed into all parts of hands using the 6-step technique, until the alcohol has evaporated. Washing hands with soap and water is always recommended because alcohol is less effective on micro-organisms such as Clostridium Difficile and viral causes of gastroenteritis.
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INFECTION CONTROL
A selection of personal protective equipment (PPE) should be based on an assessment of the risk of transmission of micro-organisms to the service user and the risk of contamination of a member of staff’s clothing and skin by the service user’s bodily fluids, secretions or excretions.
Disposable gloves and aprons protect the staff and the service user from crossinfection. The selection of the appropriate materials should be subject to careful
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INFECTION CONTROL assessment of the task to be carried out and its related risk to the resident and the staff. For example there is an increase in the amount of people allergic to latex, so latex gloves are no longer appropriate for use in care establishments.
Vinyl gloves or nitrite gloves are more suitable.
DISPOSABLE GLOVES - Gloves reduce the risk of contamination but do not eliminate it, therefore gloves are not a substitute for hand hygiene.
Disposable gloves are required when contact with blood or bodily fluids or nonintact skin in anticipated.
They should be single use and well-fitting.
Gloves should be discarded after each care activity for which they are worn and before contact with other items such as door handles, telephones, pens etc. This will prevent the transmission of micro-organisms to other sites and other service users.
It is never acceptable to wash gloves rather than change them.
Hands should always be decontaminated following removal of gloves as the integrity of gloves is not guaranteed and hands may become contaminated during their removal.
DISPOSABLE PLASTIC APRONS – Aprons should be worn by care staff when there is a risk of clothing being contaminated with blood and other bodily fluids, or when a service user has a known infection.
A disposable plastic apron should be worn during direct care, bed making or when undertaking the decontamination of equipment.
The apron is a single use item used for one procedure or episode of care and then discarded as clinical waste on completion of the task.
Aprons should be stored so that they do not accumulate dust that may act as a reservoir for micro-organisms.
FACE MASKS AND EYE PROTECTION – These should only be used when caring for service users on the advice of the infection prevention and control personnel and may be required if there is a risk of blood and bodily fluid splash into the eyes, nose and mouth.
UNIFORM – Uniforms do not constitute protective equipment. A clean uniform should be worn for each shift. Uniforms have short sleeves. During the working day uniforms will become contaminated with micro-organisms. Disposable aprons will protect the uniform from gross contamination only. Uniform should be able to withstand a wash temperature of 60°C. Staff should change into normal clothing at the end of the working day. If wearing uniform to and from work is unavoidable, cover uniform with an outer layer. If working in an establishment where staff wear their own clothes, similar hygiene measures should be employed.
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INFECTION CONTROL
Sharps are medical devices like needles, scalpels, and other tools that cut or go into the skin. Learning how to safely handle sharps is important to prevent accidental needle stick injuries and cuts.
Before you use a sharp object, such as a needle or scalpel, make sure you have all the items you need close by. This includes items like alcohol swabs, gauze, and bandages.
Also, know where the sharps disposal container is. Check to make sure there is enough room in the container for your object to fit. It should not be more than 2/3 full.
Some needles have a protective device, such as a needle shield, sheath, or blunting, that you activate after you remove the needle from the patient. This allows you to handle the needle safely, without the risk of exposing yourself to blood or body fluids. If you are using this kind of needle, make sure you know how it works before you use it.
Follow these guidelines when you work with sharps.
 Do not uncover or unwrap the sharp object until it is time to use it.
 Keep the object pointed away from you and other persons at all times.
 Never recap or bend a sharp object.
 Keep your fingers away from the tip of the object.
 If the object is reusable, put it in a secure, closed container after you use it.
 Never hand a sharp object to someone else or put it on a tray for another person to pick up.
 Tell the people you are working with when you plan to set the object down or pick it up.
Make sure the disposal container is made for disposing of sharp objects. Replace containers when they are 2/3 full.
Other important tips include:
 Never put your fingers into the sharps container.
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INFECTION CONTROL
 If the needle has tubing attached to it, hold the needle and the tubing when you put it in the sharps container.
 Sharps containers should be at eye level and within your reach.
 If a needle is sticking out of the container, do not push it in with your hands.
Call to have the container removed. Or, a trained person may use tongs to push the needle back into the container.
 If you find an uncovered sharp object outside of a disposal container, it is safe to pick it up only if you can grasp the non-sharp end. If you cannot, use tongs to pick it up and dispose of it.
ACTION TO BE TAKEN FOLLOWING SHARPS INJURY
Encourage wound to bleed
Do not suck the area
Wash /irrigate with warm running water and antiseptic soap
Do not scrub the area
Cover the injury with a waterproof dressing
Make sure item that caused injury is disposed of safely
Report it to a senior member of staff, following policies with care establishments
Record in Incident book or datix system of care establishments
Report to Aberness Recruitment Office
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INFECTION CONTROL
Contact A&E department or Occupational Health or GP immediately
Make sure you receive appointment follow up, such as full course of post exposure prophylaxis if you need it.
SHARPS CONTAINERS – Should comply with European and British Standards
(BS7320, 1990). They should:

Have a handle and an effective closure device

Be resistant to penetration

Not leak or break when dropped
 Be yellow and marked with the wording “Danger–contaminated sharps only – destroyed by incineration”

Be marked to indicate when 75% full and should never be filled above this mark

Be securely closed and labelled with the date and origin before being sent for disposal

Be correctly assembled especially at the corners.
The Environmental Protection Act 1990 applies to waste disposal. The legislation refers the Duty of Care, which places a duty of care on all persons producing waste to safely manage the handling and disposal of the waste in the correct and proper manner. Healthcare waste must be managed in accordance with current legislation and national guidelines.
All Healthcare establishments will have a waste policy in place. Under section 16 of the Care Homes Regulations, care homes are also obliged to have suitable arrangements in place for the disposal of waste.
Clinical Waste is divided into two categories, waste that poses a risk of infection and medicinal waste. All clinical waste must be disposed of in the appropriate coloured bags:

Radioactive Waste – place radioactive “over stickers” on the yellow bag

Cytotoxic Waste – place in purple/yellow receptacle for incineration

Infectious Waste – Category A (anatomical waste, highly infectious) place in yellow bag, label bag with source, tie bag securely at neck. Must be disposed of by incineration

Infectious Waste – Category B (infectious dressings, pads, catheter bags, suction liners) place in orange bag which may need treatment to render safe prior to disposal

All medicinal waste should be disposed of appropriately as per care establishment’s policies.
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INFECTION CONTROL
Disposal of non-clinical waste, which includes incontinence and other waste produced from humans and domestic waste is disposed of in black bags.
Label bag with source and tie bag securely at the neck.
STORAGE OF CLINICAL WASTE

Pedal bins must be available where clinical waste and contaminated household waste are generated

Bins must be lined with the appropriate colour liner

Remove clinical waste bags when they are 3/4s full or at the end of the day, as appropriate

Securely tie bags as per the arrangements in the care establishment you are working in.

Label clinical waste bags and sharps boxes with the address of where the waste was produced. This may be using labelled tape or clips, or simply writing the address or post code in permanent marker pen onto the bag prior to use

Hold bags by the neck and do not throw them.

Clinical waste should be stored in a designated waste collection point or wheeled bin away from residential and food preparation areas.
Ideally in a locked fixed or wheeled external bin awaiting collection.

Bins provided for clinical waste must be kept in a secure locked location, that is well-lit, ventilated and marked with warning signs

Waste must be collected by a registered carrier at regular intervals e.g. weekly

Waste contractors are under no obligation to remove waste if it does not adhere to the duty of care e.g. packaged and labelled incorrectly
HOUSEHOLD/DOMESTIC WASTE

Pedal operated bins are recommended, though open bins are adequate for paper towels

Any waste that is not covered by the clinical waste group is classed as household waste

This waste must be disposed of though the normal household waste stream, usually black bin bags. Where possible recycling or re-using options should be considered

Household waste and clinical waste must be kept separate at all times

Reducing waste can save money and help to improve the environment
Linen may be contaminated with bodily fluids. Inspect linen when removed.
Bed linen should not be shaken and it must be removed with care, avoiding the creation of dust and dissemination of skin scales.
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INFECTION CONTROL
If fouled, linen should always be removed using gloves and disposable aprons. If solid matter is present, this must be removed using disposable paper and disposed of in the toilet. Do not sluice by hand as this may spray micro-organisms onto surfaces, uniform and skin. The soiled linen should then be carefully put into red alginate bag which should be tied carefully and then placed in red linen bag for washing. At no time should fouled linen be put onto the floor. Fouled linen should not be handled any more than is necessary.
Laundering of Uniforms and Infection Control
– Aberness Recruitment staff are expected to launder their own uniforms daily, in order to control the spread of infection and to ensure decontamination following contact with contaminated products. Uniforms should be washed at 60°C or above, separately form the normal everyday washing cycle. A clean uniform should be used for each shift/assignment.
Shoes should be cleaned after each shift to avoid cross-contamination.
Aseptic technique is a procedure used by medical staff to prevent the spread of infection. The goal is to reach asepsis , which means an environment that is free of harmful microorganisms. Each healthcare setting has its own set of practices for achieving asepsis. Common examples include surgery rooms, clinics, and treatment rooms in care homes.
The principles of aseptic technique require that:

Exposure of a susceptible site is kept to a minimum

Appropriate hand decontamination is performed prior to the procedure

Sterile gloves are used if susceptible body sites are likely to be touched or if sterile parts of devices need to be handled during a procedure

All fluids and materials used are sterile

Sterile packs are checked for expiry date and for evidence of damage or moisture penetration

Contaminated/non-sterile items are not placed in the sterile field

Single use items are never re-used

Movement in the immediate vicinity of the area in which the procedure is to be performed is minimised
The principles of asepsis play a vital role in the prevention of infection in all environments. It is the responsibility of each staff member to understand these principles and to incorporate them into their everyday practice, where this is applicable.
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INFECTION CONTROL
Invasive devices such as urinary catheters or intravenous or subcutaneous line will increase a service user’s risk of acquiring and infection and the care establishment should have policies in place for the care of such devices.
Where a service user has an invasive device in situ, this should be fully documented in their care plan and the service user should be monitored for any signs of infection. Staff should be trained in the care of residents with invasive devices and in how to recognise signs and symptoms of infection.
URINARY CATHETERS – Service users with a urinary catheter in place are at an increased risk of acquiring an infection. Bacteria can enter the urethra and the point where the catheter enters the body. The date of catheter insertion and the indication for insertion should be recorded in the service user’s care plan. This should be reviewed regularly by the GP or nurse and the urinary catheter removed as soon as possible. To minimise the risk of the service user developing an infection:

Hands should be washed and a clean pair of non-sterile gloves should be put on before handling the catheter or drainage bag. Hands should be cleaned again after removing the gloves.

The point at which the catheter enters the body should be cleaned daily with soap and water.

The drainage bag or catheter valve should be connected to the catheter at all times, except when changing the bag. This ‘closed system’ reduces the risk of infection

At night, the night drainage bag should be added without breaking the closed system

The drainage bag should be kept lower that the bladder to allow urine to drain

The bag should not be allowed to touch the floor as this can increase the risk of infection. Catheter bag stands should be used.

The drainage bag should be emptied regularly to maintain the flow of urine.
ENTERAL FEEDING – is prescribed for service users who cannot eat normally. Liquid feed is given through a fine tube that enters the body by one of three ways: a. Through the nose into the stomach – naso-gastric; b. directly into the stomach
– gastrostomy or PEG; and c. Directly into the small bowel – jejunostomy.
To minimise risk of infection:
 Feed should be stored according to the manufacturer’s instructions

Hands should be cleaned thoroughly before preparing the feed or touching the equipment
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INFECTION CONTROL

Equipment should be handled as little as possible

The insertion site or stoma, should be cleaned with water every day and dried well

To prevent blockage, the enteral feeding tube should be flushed with fresh water before and after feeding or administering medications.
Enteral feeding tubes for people whose immune system is not functioning properly, would be flushed with either cooled freshly boiled water or sterile water.

Minimal handling and aseptic technique should be used to connect the administration system to the feeding tube.

A pack of pre-packed feed can be used for up to 24 hours in a feeding session. Feeds that have been prepared on site should not be used for longer than 4 hours in a feeding session.

After each session, the bags and administration sets should be disposed of as household waste.
In general, it is considered that the environment has a relatively low role in the transmission of infection. However the environment is known to play an important role in cross infection during outbreaks. Door handles, flush handles, taps etc. have all been implicated. Accumulation of dust, dirt and liquid residues will increase infection risks and must be reduced to the minimum. Audit programmes for monitoring the standard of hygiene are usually in place in most care establishments. At times care staff are responsible for cleaning, when there has been a spillage or after mealtimes when the domestic staff have left at the end of the day.
Domestic Cupboards
– should be locked at all times and accessible to care staff if cleaning products are required out with domestic staff hours.
Disposable non-shedding cloths or paper roll should be provided for cleaning purposes. Equipment and materials for general cleaning should be kept separate forms those used for the cleaning of bodily fluid spillage. Cloths and mops should not be stored in disinfectant or buckets. Colour coding of cleaning equipment is required. Each care establishment will have its own policy and procedure on Infection Control.
GREEN
– Kitchens only, never used elsewhere
BLUE - General areas e.g. offices and departments
YELLOW – Washbasins, washroom surfaces
RED
– High risk areas e.g. sluices, toilets, washroom floors
WHITE – Isolation rooms, operating theatres
Each care establishment will have guidelines as to what cleaning products to use in certain areas. Follow manufacturer’s instructions on use. A COSSH
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INFECTION CONTROL assessment is required and should be in place for any cleaning materials used.
Spillages of blood and high-risk bodily fluids must be dealt with quickly and effectively. Disposable gloves and an apron must be worn and the contaminated debris treated as clinical waste. Check the policy of the care establishment as to which product is to be used for cleaning the spillage and follow the manufacturer’s guidelines. Dispose of all materials as per guidelines and discard protective clothing and wash hands.
For low-risk spillages e.g. urine, faeces, vomit, use a solution of detergent and water with paper towels or disposable cloths. Rinse and dry thoroughly.
Dispose of all materials and discard protective clothing and wash hands.
Communicable diseases spread from one person to another or from an animal to a person. The spread often happens via airborne viruses or bacteria, but also through blood or other bodily fluid. The terms infectious and contagious are also used to describe communicable disease. Examples include:

MRSA (Methicillin Resistant Staphylococcus Aureus)

Clostridium Difficile

HIV and AIDS

Hepatitis

Meningitis

Influenza

Measles, mumps and rubella
AGENCY STAFF WITH COMMUNICABLE DISEASE
Aberness Recruitment recognises that agency staff with communicable diseases may still be capable of fulfilling nursing or care tasks. The main principle to be considered however is the safety and wellbeing of the service users, even when the level of risk is thought to be low. This principle should be applied by you when deciding whether to make yourself available for work at all times during assignments, as well as by your line manager considering your suitability for specific assignments.
In all assignments, it is your individual responsibility to take adequate precautions to protect the service users from communicable diseases. If you are suffering from an illness, especially diarrhoea and vomiting, influenza or any skin problem, you should contact your line manager immediately. You will not be able to work until you have completely recovered.
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INFECTION CONTROL
If you are involved in an incident of exposure to a communicable disease whilst at work, contact your line manager immediately in order that we can advise you and follow up on your treatment.
CLIENTS WITH COMMUNICABLE DISEASES
Aberness Recruitment recognises the rights of all Service users to receive appropriate care, regardless of their condition or circumstances, which give rise to their need for care. Service users are expected to disclose any communicable diseases to which there is a risk of exposure and to give consent, for GPs, nurses and other health professionals to disclose and discuss such information.
Service users have a right to be protected from preventable infection and agency staff have a duty to safeguard their well-being. Good basic hygiene practises should be followed at all times
Line managers will brief staff on known conditions or communicable diseases relating to care establishments they are being assigned to, to enable them to provide appropriate care, but it will be stressed that best practise for infection control should be followed in all cases, not just those where a specific risk is known.
Health Protection Scotland (HPS) hosts a site dedicated to hand washing and hand washing promotional material.
http://www.washyourhandsofthem.com/home.aspx
Infection Prevention and Control Guidelines for NHS and non- NHS
Community and Primary Care settings has useful information and a guide to
‘cough etiquette’
.
http://www.hps.scot.nhs.uk/
General information and infection prevention and control precautions to prepare for and manage norovirus in care homes updated August 2014 available from http://documents.hps.scot.nhs.uk
All those persons referred to within the scope of this policy are required to be familiar with the terms of this policy.
Maintenance, regular review and updating of this policy is conducted and agreed by the Director. Revision, amendments and alterations to the policy can only be implemented following consideration and approval by the Director of Aberness Recruitment Agency.
Dawn Knowles | JAN 2015