Infection control in general practice

Infection control was an issue in eight in ten practices that MPS conducted risk assessments for during 2011. Kate Taylor, a registered nurse and Clinical Risk Manager at the Medical Protection Society (MPS), looks at the key reasons for this and how to manage infection.

It's a busy Friday morning at the practice and you are holding the travel vaccination clinic. Amidst the hustle and bustle of the clinic, if you inadvertently sustained a needle stick injury, would you know what to do? Does your practice have a practice infection control policy that includes information pertaining to sharps injuries?

All employers are required to ensure, so far as reasonably practicable, the health, safety and welfare of employees, under the Health and Safety at Work Act (1974).¹ This act requires employers to provide a safe working environment in relation to sharps injuries, together with safe equipment, training, information and instructions on safe systems of work.

But infection control in general practice is not just related to preventing sharps injuries, it covers much more. Nurses in general practice play a vital role in guiding the team on infection prevention and control.

WHAT IS HEALTHCARE ASSOCIATED INFECTION?

Health care associated infections (HCAIs) are infections that are acquired as a result of healthcare interventions.² There are a number of factors that can increase the risk of acquiring an infection,³ but high standards of infection control minimise the risk of occurrence (HPA 2012).² It is estimated that 300,000 patients per year acquire an HCAI as a result of NHS care, costing the NHS £1 billion a year (NICE 2012).⁴ However, HCAIs are not just confined to hospitals, and health care workers who practise in community settings (including GP practices) have the same responsibilities to prevent opportunities for infection to occur. You often hear about Norovirus outbreaks at hospitals; however there are also risks in general practice for patients to contract impetigo, chicken pox or colds and flu, and even blood borne infections such as hepatitis B and HIV as a result of needlestick injuries.

Patient safety is intrinsic to MPS and one of our aims is to work with healthcare professionals through education and risk management to prevent avoidable harm to patients. We have developed a Clinical Risk Self Assessment (CRSA) for general practice, which is a systematic approach to identifying risks and developing practical solutions to ensure quality of practice, and preventing harm to patients.⁵

Over the past nine years MPS has conducted more than 800 CRSAs in general practice across the UK and Ireland. The results from over 150 CRSAs conducted during 2011 revealed that 82% of practices visited had issues in relation to infection control.

Below are some of the key risks and how these may impact on your practice.

KEY RISKS

Cleaning of premises

Of the practices visited in 2011, 37% had risks associated with cleaning of the premises; this did not relate to the effectiveness or efficiency of those undertaking the housekeeping roles but rather the schedule of cleaning for each individual practice.

Practices should ensure that they have a regular planned and monitored cleaning schedule which provides details about how the environment and equipment, such as chairs, examination couches and toys are to be cleaned and how frequently.

Floor mops should be regularly washed and changed periodically. Mops and buckets should be colour coded and different mops should be used to clean clinical and public areas. Mops should be hung to dry and should not be left wet in buckets.

Hand washing

Almost a fifth of those practices visited had not provided staff with training on hand washing. Hand washing is the single most important step in reducing the spread of disease.

Ensure that all general practice staff receive appropriate training and use the six-step technique before and after direct contact with a patient.⁶ Replace any cloth hand towels with paper towels, as cloth towels are a recognised source of cross infection. Staff should also have access to suitable personal protective equipment such as gloves.²

Clinical waste/Sharps

Of the practices MPS visited, 20% had risks associated with clinical waste and the management of sharps. For example, not using pedal operated clinical waste bins, clinical waste bins not being provided in the GP's consulting room and inappropriate storage of clinical waste.

Practices must ensure they comply with the Control of Substances Hazardous to Health (COSHH) Regulations 2002, ensuring that all staff are instructed how to dispose of waste correctly and safely.⁷ All hazardous liquids, such as bleach, should be stored in a lockable cupboard.

COSHH also states that staff should ensure that needles are disposed of in the sharps containers at point of use. Sharps containers should be stored out of reach of children.

Specimen handling

How often do reception staff handle specimens within your practice? Are patients experts in ensuring sample bottles are not contaminated? Almost 40% of practices visited in 2011 had risks associated with specimen handling.

As part of the practice's infection control policy, reception staff should not touch patient specimens, and samples in inappropriate containers should not be accepted. Nurses - and GPs - should ensure that they issue the patient with a labelled specimen container when requesting a specimen; this should reduce the number of specimens being presented in unsuitable and unlabelled containers. It will also prevent the need for decanting samples. A box could be provided at the reception desk for patients to leave their samples, which can then be passed directly to the nursing staff.

Dealing with spillages

Spillage kits were not available in 19% of the practices visited. Ensure that the practice provides spillage kits, either purchased or made up in-house, for dealing with spillages such as body fluids, blood and mercury (if applicable). Contact your local infection control nurse about requirements for the safe cleaning of hazardous substances. It is also good practice for staff to be offered hepatitis B immunisation, in case they come into contact with infected bloods.

TODAY

General practices in England are currently preparing for registration with the Care Quality Commission (CQC) the new independent regulator of all health and adult social care in England.⁸ They set out a number of essential standards which practices must comply with, and Outcome 8 Regulation 12 relates to infection control. See 'Top Tips' to see how to comply with CQC infection control requirements.

SUMMARY

Today, patients have increased and varied expectations of their health-care needs and requirements, none more important than the expectation that healthcare providers will meet standards of hygiene. A key component to achieving this is to ensure effective infection control and prevention systems within your practice. This could be the difference between one of your patients or colleagues acquiring an infection or not. It will also help minimise your risk of complaints and claims.

REFERENCES

1. Health and Safety at Work act (1974)

http://www.hse.gov.uk/legislation/hswa.htm

2. Health Protection Agency (2012). Healthcare associated infections. http://www.hpa.org.uk/Topics/InfectiousDiseases/InfectionsAZ/HCAI/GeneralInformationOnHCAI/

3. Royal College of Nursing (2011) Sharps safety. Available at: http://www.rcn.org.uk/__data/assets/pdf_file/0008/418490/004135.pdf

4. NICE (2012) Clinical Guideline 139. Prevention and control of healthcare associated infections in primary and community care. Available at: http://www.nice.org.uk/guidance/CG139

5. Medical protection Society Clinical Risk self Assessments. Available at: http://www.medicalprotection.org/uk/education-and-events/clinical-risk-self-assessments-for-Ps

6. Ayliffe GA, Babb JR, Quoraishi AH (1978) A test for 'hygienic' hand disinfection. Journal of Clinical Pathology. 31, 10, 923-928.

7. Control of Substances Hazardous to Health (COSHH) Advice available from website: http://www.hse.gov.uk/coshh/

8. Care Quality Commission (2010). Essential standards of quality and safety. http://www.cqc.org.uk/