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Nigel's surgery 99: Infection prevention and control in General Practice

Categories:
  • Organisations we regulate,
  • GP and GP out-of-hours services

We judge compliance with registration requirements set out in the regulations.  All providers of healthcare and adult social care should meet or exceed the Code of Practice on the prevention and control of infections and related guidance.

The Code states:

“Good infection prevention (including cleanliness)1 is essential to ensure that people who use health and social care services receive safe and effective care. Effective prevention and control of infection must be part of everyday practice and be applied consistently by everyone.

Good management and organisational processes are crucial to make sure that high standards of infection prevention (including cleanliness) are developed and maintained”.

We base our expectations of registered providers on the criteria of the code. Our findings help us decide if providers deliver safe, effective and well-led services.

General requirements

  • Providers should have an effective IPC policy. This should be relevant to their practice. It should be accessible to all staff and regularly updated. It should include the contact details of the local IPC specialist team.
  • The policy should include specific requirements for higher risk procedures. For example, fitting of contraceptive devices and minor surgery.
  • There should be an IPC lead with overall responsibility for IPC. They should have the authority to lead and implement change where needed.
  • There should be an IPC audit programme, so policies and procedures are effective and up to date. There should be evidence of issues identified by the audit and how they were addressed.
  • The policy should include staff training requirements and frequency of training updates.
  • Cleaning contractors should have a schedule of general cleaning. The schedule should include cleaning frequency of specific areas, fixtures and fittings. This includes high frequency touch items such as keyboards, telephones, door handles and light switches. It should be checked regularly for compliance and in line with what the general public would expect in health care premises. The policy should include responsibilities for cleaning of specific clinical equipment.
  • Staff should have access to occupational health services. They should be immunised according to the Public Health England Green Book.
  • The policy should include the use of personal protective equipment (PPE). This includes staff training in safe use and disposal of PPE.

Specific issues

Curtains and window blinds

Curtains around examination couches may be either disposable or re-usable. There is no mandatory frequency for changing or laundering curtains. The National Specifications for Cleanliness in the NHS suggests frequency. The specifications are guidance on setting and measuring performance outcomes in primary care. We expect providers to assess the risk attached to each item, including curtains. Providers should follow their own protocol.

There should be a programme of cleaning for curtains and other window coverings in non-clinical areas. This should include regular vacuuming. The programme should 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 the frequency of cleaning carpets in consulting rooms and other communal areas. The policy should include actions to take if carpets are contaminated with body fluids or spillages.

Health care waste

Primary care providers have a statutory duty of care. It requires all reasonable measures to be taken to deal with waste appropriately. This is from point of production to final disposal.

Healthcare Technical Memorandum (HTM) 07-01 Safe Management of Healthcare Waste is a framework for best practice. It makes sure 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 be lidded and operated with a foot pedal.

  • Waste should be assessed and segregated 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.

Sharps

Sharps should be assessed and disposed of in the correct container. Containers are orange, yellow or purple lidded depending on nature of the item.

Containers should be labelled on assembly and on locking. They should not be filled above the black line. Lock and dispose of containers after three months even if not full.

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

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

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.

Last updated:
29 September 2020