INFECTION PREVENTION AND CONTROL

INFECTION PREVENTION AND CONTROL FOR PRIMARY CARE IN IRELAND

A Guide for General Practice

Authors: Helen Lemass Niamh McDonnell Dr. Nuala O'Connor Dr. Sheila Rochford

HCAI/AMR Healthcare Associated Infections and

Antimicrobial Resistance 2013

Authors: Helen Lemass, Clinical Nurse Specialist in Infection Prevention and Control,Portunculia Hospital, RGN, RCN, BSc Nursing (Ord and Hons level), Higher Diploma (Level 9) Infection Prevention and Control. Niamh McDonnell, CNS, Infection Control and Prevention, St. Finbarr's Hospital, Cork. Infection Prevention Society Dr. Nuala O'Connor, MICGP, General Practitioner. ICGP Lead HCAI/AMR . Chair of the Infection Prevention and Control Sub-committee SARI . Dr. Sheila Rochford BSc (Hons), MICGP, MMedSc, FAcadMEd, FRCGP.Chair Quality and Standards Committee ICGP

Advisory Committee: Dr.Susan Fitzgerald, Consultant Microbiologist, St. Vincent and Colmcilles Hospital. Irish Society of Clinical Microbiologists. Mary Kavanagh, Irish Practice Nurses Association. Dr. Anne Sheahan, Specialist in Public Health Medicine, HSE South, Marie Courtney, Professional Development Co-ordinator Practice Nursing.

Acknowledgments The authors wish to sincerely thank all those who commented and for their helpful feedback on this document in particular, Dr. Andree Rochfort, MICGP, LFOM, M.Med.Sc. Director of Quality Improvement, ICGP. Dr. Derval Igoe, Specialist in Public Health Medicine, HPSC. Ms. Sheila Donlon, Infection Control Manager, HPSC

Disclaimer and Waiver of Liability This document represents the opinion of the SARI Infection Prevention and Control Subcommittee, following a review of the scientific literature and an extensive consultation exercise. Responsibility for the implementation of these guidelines rests with individual practice staff and practice managers. The guide does not however override the individual responsibility of healthcare professionals to make decisions appropriate to the circumstances of individual patients in consultation with the patient and/or guardian or carer.

Whilst we accept that some aspects of the recommendations may be difficult to implement initially due to a lack of facilities or insufficient personnel, we strongly believe that these guidelines represent best practice. Where there are difficulties, these should be highlighted locally and elsewhere so that measures are taken to ensure implementation. Whilst every effort has been made to ensure the accuracy of the information and material contained in this document, errors or omissions may occur in the content. We acknowledge that new evidence may emerge that may overtake some of these recommendations. The Subcommittee will endeavour to review and revise as and when appropriate.

Terms of Reference 1. To develop guidelines on Infection Prevention and Control in Irish General Practice. 2. A document will be produced that is user friendly and reflects the needs of general practice within the context of evidence based practice. It will reflect the current statutory requirements. This document will not cover nursing homes, community hospitals or other community settings. It relates to the working environment of general practitioners, practice nurses and other staff working in the practice setting. 3. To support the Infection Control Nurse developer in the production of this document. 4. To consult with the relevant stakeholders.

Key Messages

Patients are cared for in an environment that is safe and clean, and where the risk of them acquiring an infection is kept as low as possible. A person-centered approach is taken respecting the dignity, privacy and needs of individual patients. Every interaction in general practice should include a risk assessment of the potential for infection transmission.

Hand hygiene is one of the most important methods of preventing health-care associated infections (HCAI). Alcohol based gel/foams/rubs are the preferred method for hand hygiene when the hands are not soiled and are physically clean. They should be available at point of care. Adequate hand washing facilities, liquid soap, alcohol gel/foam/rub and disposable paper towel availability and education are the cornerstones for compliance with hand hygiene guidelines (Chapter 3)

Practices that use sterile medical devices must choose from the following 3 options

1. Use sterile single use devices, which will obviate the need for decontamination.

2. Have reusable devices sterilised by a certified Sterile Services Department (SSD).

3. Decontaminate and reprocess devices in the practice

The reprocessing of reusable invasive medical devices (RIMD's) should comply with the recommendations set out in the following: -

Code of practice for decontamination of RIMD (HSE 2007). Irish Medicines Board (IMB) (2005) Guide: Manufacture of Medical

Devices within Healthcare Institutions. Safe and Effective Use of Bench-top Steam Sterilisers, IMB SN2009

(04). Irish Medicines Board (IMB): Cleaning and decontamination of

reusable medical devices IMB safety notice; SN2010 (11) (Please refer to Appendix 7 and chapter 8)

The Quality and Patient Safety Directorate have identified the need to develop Standards and Recommended Practices for decontamination of RIMD in General Practice, this piece of work will be incorporated into the Directorate plan.

Practice staff should be offered vaccination if a risk assessment reveals that there is a risk to their health and safety due to their exposure to a biological agent for which effective immunisation is available. Healthcare workers who are at occupational risk of exposure to blood or bodily fluids or who perform exposure prone procedures must be immunised against hepatitis B. Staff should

be instructed in the safe handling and packaging of pathology specimens for transport (Chapter 2).

Standard Precautions break the chain of infection. They are a set of practices that should be used in the care of all patients regardless of whether they are known or suspected to be infected with a transmissible organism. Additional precautions known as Transmission Based Precautions are required where the patient is known or suspected of having a highly transmissible infection e.g. Contact Precautions for patient with Clostridium difficile (Chapter 1).

Personal Protective equipment (PPE) should be used after a risk assessment determines the risk of transmission of microorganisms to the patient and the risk of contamination of the healthcare workers skin or clothing by the patient's blood body fluid/secretions/excretions, contact with mucous membranes and non-intact skin. Examples of PPE are gloves, aprons, respiratory mask. (Chapter 4)

Safe handling use and disposal of sharps is essential to prevent injury/ transmission of disease to patients, healthcare workers and cleaning staff. Each practice needs to have a policy in place for assessment and management of a needle stick injury. Education of all practice staff in sharps injuries prevention and management is essential. (Chapter 7)

Safe injection practices recommend the use of one sterile needle and one sterile syringe a single time. Single dose vials should be used wherever possible. (Chapter 6)

The correct management of blood and bodily fluid spills is described for spots, splashes, small and large volume spills. All practice staff need to be trained in the correct management of spills. (Chapter 10)

Cleaning and/or decontamination after risk assessment of common pieces of medical equipment used in Irish general practice are detailed. (Chapter 8)

Cleaning and/or decontamination after risk assessment of the general practice environment are detailed. (Chapter 9)

Laundry from infected patients can be contaminated with microorganisms. Disposable linen or paper towels are recommended. A contracted laundry service compliant with current Irish legislation should be used for reusable linen. Linen should be changed between patients. (Chapter 11)

Health care risk waste is defined as hazardous or dangerous due to the risk of it being infectious or because it contains used sharp materials that could cause injury. Current Irish legislation places the primary responsibility for waste and its disposal on the producer i.e. general practitioner. Proper segregation, packaging, labeling, storage and transport of health care waste are outlined. The Segregation, Packaging and Storage Guidelines for Healthcare Risk Waste (DOHC, 2010) recommends a uniform system of segregation and

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