GP mythbuster 99: Infection prevention and control in General Practice

Page last updated: 9 October 2023
Categories
Organisations we regulate

This has been fully updated in September 2023. We have updated the reference to The Green Book in October 2023.

All providers of health care and adult social care should meet or exceed the Health and Social Care Act 2008 code of practice on the prevention and control of infections and related guidance.

The key messages of the code are:

  • preventing and controlling infection ensuring people receive safe and effective care
  • all staff must apply this as part of everyday practice
  • high standards of infection prevention and cleanliness need good management and processes.

The National Standards of Healthcare Cleanliness 2021 replace the 2007 specifications for cleanliness in NHS services. This guidance corresponds with the Health and Social Care regulations and the code of practice. All these include for example:

  • infection prevention and control audit processes
  • waste management
  • cleaning schedules
  • maintenance of equipment.

We do not expect GP practices to display star ratings or any logos to show standards of cleanliness.

General requirements

Practices should have the following:

  • An effective infection prevention and control (IPC) policy. It should be relevant to the practice, accessible to all staff and regularly updated. The policy should include:
    • contact details of the local IPC specialist team
    • specific requirements for higher risk procedures. For example, fitting of contraceptive devices and minor surgery
    • staff training requirements and frequency of training updates
    • the use of personal protective equipment (PPE).This includes training staff in safe use and disposal of PPE.
    • responsibilities for cleaning specific clinical equipment.
  • A lead person with overall responsibility for IPC. They should have the authority to lead and implement change where needed.
  • An IPC audit programme to ensure policies and procedures are effective and up-to-date. There should be evidence of issues identified by the audit and how they were addressed.

Cleaning contractors should have a schedule of general cleaning. The schedule should:

  • include cleaning frequencies of specific areas, fixtures and fittings. This includes high frequency touch items such as keyboards, telephones, door handles and light switches
  • be checked regularly for compliance
  • be in line with what the public expect in healthcare premises.

Staff should have access to occupational health services. They should be immunised according to The Green Book (UK Health Security Agency).

Specific issues

Curtains and window blinds

Curtains around examination couches may be either disposable or re-usable. CQC do not set mandatory frequency for changing or laundering curtains. Guidance can be found in the National Standards of Healthcare Cleanliness and appendices. These specifications provide guidance on setting and measuring performance outcomes in primary care. We expect practices to assess the risk attached to each item, including curtains, and follow your own protocol.

There should be a programme of cleaning for curtains and other window coverings in non-clinical areas. This should:

  • include regular vacuuming
  • specify when curtains will be cleaned.

Curtains should be changed immediately if visibly soiled or stained.

Carpets

Clinical rooms should not have carpets. There should be a policy for cleaning carpets in consulting rooms and other communal areas including:

  • How often they are cleaned
  • What actions to take if carpets are contaminated with body fluids or spillages.

Health care waste

You must take all reasonable measures to deal with waste appropriately. This is from point of production to final disposal.

The Healthcare Technical Memorandum (HTM) 07-01 Safe Management of Healthcare Waste is a framework for best practice. It makes sure that legislation such as Health and Safety at Work regulations are met.

General clinical waste

Bins should be easily accessible to staff at point of use. In clinical areas, they should have lids and operate with a foot pedal.

  • Assess waste and segregate it appropriately.
  • Waste bags should be:
    • maximum two thirds full and securely tied
    • labelled with the address and date before collection
    • stored in a secure, clean designated area while awaiting collection.

Medicines waste

Medicines waste must be stored in a designated bin. An appropriate waste contractor should collect this waste regularly. Staff should know which medicines to dispose in each bin.

Purple topped bins, including sharps bins, for cytotoxic medicines (which include hormones) should be available.

  • Denaturing kits for controlled drugs (CDs), where provided, must be available. There should be:
    • a written procedure to govern the process
    • evidence that dispensary stock controlled drugs are only disposed of in the presence of an authorised witness.

You must treat labels, prescriptions and other patient identifiable documents as confidential waste.

Sharps

Sharps should be assessed and disposed of in the correct container. Containers have either orange, yellow or purple lids, depending on nature of the item being disposed.

Containers should be labelled when assembling and when locking. Bins must be disposed of when they reach the fill line.

To achieve sustainability, some healthcare facilities are increasingly considering and using reusable sharps container systems. All sharps containers should be managed in line with national guidance and manufacturer’s instructions.

Hand hygiene

Adequate handwashing facilities must be available and easily accessible for all staff. This should allow washing hands in hot water using the correct technique.

Liquid soap, paper towels and alcohol gel should be available. Hand hygiene should be included in staff training.

Disposable gloves and other PPE should be available and used as appropriate, with staff training being provided where necessary.

See Management and disposal of healthcare waste.

All staff should be assessed for risk of contracting blood borne viruses. They should be offered vaccination as appropriate. See Immunisation of healthcare staff

The process for action following a sharps injury should be clear and accessible to all staff.

Hand hygiene

You must have adequate handwashing facilities that are easily accessible for all staff. This should allow staff to wash hands using the correct technique. These facilities should include:

  • liquid soap, paper towels and alcohol gel
  • disposable gloves and other PPE

Include hand hygiene and PPE us in staff training.

See Standard infection control precautions

What we look at

When we inspect the management of infection prevention and control, we assess against:

Further information

GP mythbusters