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General Practice
1
Name
Job Title
Preventing
Infection Workbook and Guidance for
General Practice
2nd Edition
SAMPLE
General Practice
3 Co
nte
nts
Contents Page Tick when completed
1. Introduction 4
2. Infection prevention and control 5
3. Standard precautions 10
4. Hand hygiene 11
5. Personal protective equipment 17
6. Sharps management 21
7. Blood and body fluid spillages 25
8. Waste management 29
9. Laundry 33
10. Decontamination of equipment 35
11. Isolation 39
12. Environmental cleanliness 41
13. Aseptic technique 43
14. Specimen collection 47
15. Viral gastroenteritis/Norovirus 51
16. Clostridium difficile 54
17. MRSA 59
18. PVL - Staphylococcus aureus 63
19. MRGNB 67
20. CPE 69
Commentary 73
Key references 74
Certificate of completion 75
Secti
on
1
Secti
on
2 -
Sta
nd
ard
pre
ca
uti
on
s
Secti
on
3 -
Secti
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4 -
S
ecti
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5
Sp
ec
ific
in
fec
tio
ns
Ke
y
top
ics
SAMPLE
Preventing Infection Workbook and Guidance
4
1. Introduction As a community NHS Infection Prevention and Control (IPC) team
based in North Yorkshire, our aim is to support the diversity of health
and social care providers in promoting best practice in infection
prevention and control. Now in its 2nd edition, this Workbook for
General Practice complements a range of educational infection
prevention and control resources which can be viewed at:
www.infectionpreventioncontrol.co.uk
This Workbook and Guidance is intended to be the foundation for
best practice for infection prevention and control. By applying the
principles within the Workbook you will demonstrate commitment to
high quality care and patient safety. The Francis Report 2013 states
“It is unacceptable for a patient to be injured by contracting certain
types of infection as a result of the failure to apply methods of
hygiene and infection control accepted by a specified standard-
setting body, preferably NICE”. The Workbook and Guidance is
aimed at all staff working in a General Practice, this includes not
only front-line clinical staff, but all staff groups including receptionists
and cleaning staff.
The Workbook has been designed to be undertaken in stages. This
will allow you to complete the ‘Test your knowledge’ questions
before moving on to the next section. On completion, your manager
will check that you have achieved 100% competency in your
infection prevention and control knowledge and then sign the
‘Certificate of completion’. You should keep the Workbook as
evidence of learning and as an on-going reference guide to provide
you with easily accessible advice for day-to-day care of patients.
The Workbook is evidence-based and includes latest national
guidance. Completion of this Workbook also helps your General
Practice demonstrate compliance with the Health and Social Care
Act 2008 and Care Quality Commission requirements in
relation to infection prevention and control training.
Dr Richard Hobson
Director of Infection Prevention and Control/
Consultant Microbiologist
Harrogate and District NHS Foundation Trust
1.
In
tro
du
cti
on
SAMPLE
General Practice
5 2.
In
fec
tio
n p
rev
en
tio
n a
nd
co
ntr
ol
2. Infection prevention and control The Health and Social Care Act 2008: Code of Practice on the
prevention and control of infections and related guidance
(Department of Health, January 2015), states that, “Good
infection prevention (including cleanliness) is essential to ensure
that people who use health and social care services receive safe
and effective care”.
Infection prevention and control is a key priority for the
Department of Health, reinforced with the standards set out in
the Health and Social Care Act 2008 and the Care Quality
Commission (CQC) requirements. Infection prevention and
control spans the five key questions the CQC will be asking
about your service:
How safe? How effective? How caring?
How responsive? How well-led?
An infection occurs when micro-organisms enter the body and
cause damage. These micro-organisms can come from a
variety of sources and often take advantage of a route into the
body provided by a wound or an invasive medical device, e.g.,
catheter.
Some infections can reach the bloodstream. When this occurs it
is known as a bacteraemia, which can cause serious or life
threatening infection and can result in death.
Infection prevention and control means doing everything
possible to prevent infection from both developing and spreading
to others. Understanding how infections occur and how different
micro-organisms (germs), such as bacteria, viruses and fungi,
spread is essential to preventing infections.
Healthcare associated infections
The term healthcare associated infection (HCAI) refers to
infections associated with the delivery of healthcare in any
setting, e.g., hospitals, GP surgeries, care homes, in a
SAMPLE
General Practice
7 2.
In
fec
tio
n p
rev
en
tio
n a
nd
co
ntr
ol
Vaccines Vaccines can prevent transmission of disease from person-to-
person by both patients and staff. Staff should be aware of their
immune status in accordance with the guidance Immunisation
Against Infectious Disease (The Green Book) Chapter 12.
Correct storage of vaccines is essential to maintain their efficacy. If
vaccines are not stored correctly they may lose their effectiveness.
Over time vaccines naturally biodegrade and storage out of
temperature may hasten the loss of potency. This may result in the
vaccine failing to create the desired immune response, thereby
providing poor protection. Practices should ensure vaccines are
stored in line with the guidance in The Green Book or local Vaccine
Cold Chain Policy.
FACT
Every year there are over 300,000 cases of healthcare
associated infection (HCAI) in England and it is thought that up
to 30% of HCAIs are preventable.
In 2007, there were 9,000 deaths due to HCAI in both hospital
and primary care settings in England.
This costs the NHS £1 billion a year and £56 million of this is
estimated to be incurred after patients are discharged from
hospital.
Antimicrobials It is important to ensure appropriate antimicrobial use to optimise
patient outcomes and to reduce the risk of antimicrobial resistance.
General Practice prescribing accounts for 80% of NHS antibiotic
use and this antibiotic use must be both necessary and appropriate.
Antibiotics should not be prescribed for viral infections.
The Antimicrobial stewardship: systems and processes for effective
antimicrobial medicine use (NICE Guidance NG15, August 2015)
recommends that GPs and nurse prescribers “should support the
implementation of local antimicrobial guidelines and recognise their
importance for antimicrobial stewardship”.
SAMPLE
General Practice
9 2.
In
fec
tio
n p
rev
en
tio
n a
nd
co
ntr
ol
Chain of infection showing how MRSA can be spread
Case study: Mr Brown aged 92, has a leg ulcer which is
colonised with MRSA. A practice nurse dresses the wound and
does not wash her hands after removing her apron and gloves.
She then attends to 85 year old Mrs Smith who has a small wound
on her ankle. She transmits MRSA to her when cleaning the
wound and applying a new dressing.
Three days later Mrs Smith is very
unwell and is admitted to hospital with
MRSA bacteraemia (a life threatening
bloodstream infection).
Example of how to break the chain of MRSA infection
How to break the link
Hand hygiene
How to break the link
Hand hygiene
Patients with non-intact skin, e.g., wounds
MRSA
Leg ulcer wound
Wound exudate
Via hands
Skin wound, e.g., ankle wound
Organism
Means of transmission
Reservoir
Portal of
entry
Peo
ple a
t
risk
Port
al o
f
exit
SAMPLE
General Practice
11 4.
H
an
d h
yg
ien
e (S
tan
dard
pre
ca
uti
on
)
4. Hand hygiene Evidence and national guidance identifies that effective hand
hygiene results in significant reduction in the carriage of
potential pathogens (harmful micro-organisms) on the hands.
Effective hand hygiene decreases the incidence of healthcare
associated infection (HCAI) leading to a reduction in patient
morbidity (disease) and mortality (death).
Hand hygiene is the single most important way to prevent the
spread of infection. Hands may look visibly clean, but micro-
organisms are always present, some harmful, some not.
Removal of transient micro-organisms is the most important
factor in preventing them from being transferred to others.
Hands may become contaminated by direct contact with a
patient, handling equipment and contact with the general
environment.
Hand hygiene refers to the process of hand decontamination
where there is physical removal of dirt, blood, body fluids and
the removal or destruction of micro-organisms from the
hands.
There are two categories of micro-organisms present on
the skin of the hands
Transient bacteria are found on the surface of the
skin. They are called ‘transient’ as they do not
routinely live on the hands. They are transferred to
hands after contact with patients or the environment
and are easily removed by routine handwashing with
liquid soap and warm water.
Resident bacteria are found on the hands in the deep
layers and crevices and live on the skin of all people.
They play an important role in protecting the skin from
harmful bacteria and are not easily removed by routine
handwashing with liquid soap and warm water.
Tra
nsie
nt
Re
sid
en
t SAMPLE
General Practice
19
Eye protection
Safety glasses or a visor should be worn when there is a risk
of splashing of blood and/or body fluids to the eyes to prevent
infection. Reusable eye protection should be decontaminated
after each use (see section 10, page 35).
Masks
A splash resistant surgical mask should be worn when there
is a risk of splashing of blood and/or body fluids to the nose
or mouth. Masks may be required to be worn on other
occasions, e.g., in the event of pandemic flu.
5.
P
ers
on
al p
rote
cti
ve
eq
uip
men
t (S
tan
dard
pre
ca
uti
on
)
White Clinical tasks, e.g., wound dressing.
Yellow Cleaning of treatment and minor operation rooms.
Blue Cleaning of general areas, e.g., consulting rooms.
Red Cleaning of sanitary areas.
Green Cleaning of kitchen areas.
Order for putting on PPE Order for removing PPE
Pull apron over head and fasten at back of waist.
Secure mask ties at back of head and neck. Fit flexible band to nose bridge.
Place eye protection over eyes.
Extend gloves to cover wrists.
Grasp the outside of the glove with opposite gloved hand, peel off. Hold the removed glove in the gloved hand. Slide the
fingers of the ungloved hand under the remaining glove at the wrist and peel off.
Unfasten or break apron ties. Pull apron away from neck and shoulders lifting over head, touching inside of the apron only. Fold or roll into a bundle.
Handle eye protection only by the headband or the sides.
Unfasten the mask ties—first the bottom, then the top. Remove by handling ties only.
Clean your hands before putting on and after removing PPE.
SAMPLE
General Practice
23 6.
S
ha
rps
ma
nag
em
en
t (S
tan
da
rd p
rec
au
tio
n)
In the event of a needlestick/sharps injury
1. Encourage bleeding of the wound
by squeezing under running
water (do not suck the wound).
2. Wash the wound with liquid soap
and warm water and dry.
3. Cover the wound with a
waterproof dressing.
4. Report the injury to your manager
immediately.
5. Immediately contact your GP or Occupational Health
department. Out of normal office hours, attend the nearest
Accident and Emergency (A&E) department.
6. If you have had a needlestick/sharps injury from an item
which has been used on a patient (source), the GP in
charge of their care may take a blood sample from the
patient to test for hepatitis B, C and HIV (following
counselling and agreement of the patient).
7. At the GP practice/Occupational Health/A&E department:
a blood sample will be taken from you to check your
hepatitis B vaccination/antibody levels and you will be
offered immunoglobulin if they are low. The blood
sample will be stored until results are available from the
patient’s blood sample. If the source of the sharps
injury is unknown, you will also have blood samples
taken at 6, 12 and 24 weeks for hepatitis C and HIV
if the patient (source) is known or suspected to be HIV
positive, you will be offered Post Exposure HIV
Prophylaxis (PEP) treatment. This should ideally
commence within 1 hour of the injury, but can be
given up to 2 weeks following the injury.
SAMPLE
General Practice
25 7.
B
loo
d a
nd
bo
dy f
luid
sp
illa
ge
s (S
tan
dard
pre
ca
uti
on
)
7. Blood and body fluid spillages Blood and body fluids may contain a large number of micro-
organisms, which should be made safe immediately following
any spillage of blood or body fluids. Dealing with a spillage
may expose the member of staff to infection, therefore,
appropriate personal protective equipment should be worn
and standard precautions followed.
Blood/blood stained body fluid spillages
Disinfect spillages promptly and clean the affected area (see
table below). All blood/blood stained body fluid spillage
waste should be disposed of as infectious waste.
Best practice is to use a chlorine-based blood spillage kit,
which should be used following the manufacturer’s guidance.
Alternatively, use chlorine-based granules as below. * See note on page 27 regarding use on soft furnishings and carpets.
Action for blood/blood stained body fluid spillages 10,000 parts per million (ppm) available chlorine granules
Use Sodium Dichloroisocyanurate (NaDCC), e.g., Haz-Tab or Actichlor granules, as per manufacturer’s instructions.
1. Wear a disposable apron and gloves (PPE).
2. Ventilate the area, e.g., open windows and doors, as fumes will be released from the chlorine.
3. Sprinkle granules directly onto the spillage. Leave for the required contact time which is specified on the container.
4. Clear away the granules and dispose of as infectious waste.
5. With a disposable cloth, wash the area using detergent and warm water, then dry with paper towels.
6. Dispose of cloth and paper towels as infectious waste.
7. Remove PPE and dispose of as infectious waste.
8. Wash hands thoroughly to prevent the risk of transmission of infection.
SAMPLE
General Practice
31 8.
W
as
te m
an
ag
em
en
t (S
tan
dard
pre
ca
uti
on
)
Colour stream Description
Orange Infectious waste, which contains infectious
materials from known or suspected
infectious source, e.g., contaminated PPE,
contaminated dressings, very small pieces
of body tissue.
Waste from blood and/or body fluid
spillages.
Infectious waste may be treated to render it
safe prior to disposal, or alternatively it can
be incinerated.
Purple Cytotoxic and cytostatic waste, e.g.,
hormone or oxytocin-based agents.
Cytotoxic and cytostatic waste must be
incinerated in a permitted or licensed
facility.
Yellow and black Offensive/hygiene waste, e.g., feminine
hygiene waste, nappies from healthy
children, uncontaminated PPE,
uncontaminated dressings.
Offensive/hygiene waste may be land filled
in a permitted or licensed facility.
Black Domestic waste, which does not contain
infectious materials, sharps or medicinal
products, e.g., newspapers, paper towels
from hand washing, uncontaminated couch
roll, packaging from instruments.
Domestic waste may be land filled in a
permitted or licensed site.
Clear or opaque receptacles can also be
used for domestic waste.
Recycling options should be considered
where available.
SAMPLE
Preventing Infection Workbook and Guidance
34 9.
L
au
nd
ry (S
tan
dard
pre
cau
tio
n)
Remember
Changing of curtains and screens should documented.
Pillows should be encased in a cleanable plastic case.
Test your knowledge Please tick the correct answer True False
1. It is best practice to use disposable paper
products in General Practice.
2. Curtains and fabric screen should be
changed 3 monthly.
3. Uniforms should be washed at 30oC.
Note
Fabric hand towels should not be used in General Practice
by staff or patients as they can harbour micro-organisms
which can be transferred from one person to another.
It’s a fact
In the second half of the 19th century, commercial
laundries began using steam-powered mangles or ironers.
In 1920, the first commercially launderable permanent-
press fabrics were introduced.
In 1937 the first automatic electric washing machine was
invented.
To further reduce any micro-organisms, where possible,
uniforms or clothing should be tumble dried and/or ironed.
Always wash hands after placing uniforms or clothing in
the washing machine.
SAMPLE
Preventing Infection Workbook and Guidance
36 10
. D
eco
nta
min
ati
on
of
eq
uip
me
nt
(Sta
nd
ard
pre
ca
uti
on
) Chlorine-based disinfectants at 1,000 parts per million (ppm)
should be used for the disinfection of equipment that has
been in contact with an infected patient, non-intact skin, body
fluids (not blood) or mucous membranes, e.g., areas of the
body producing mucus, such as inside of the nose, mouth or
vagina.
Note: some chlorine-based disinfectants, e.g., Chlor-Clean,
Actichlor Plus, Tristel, contain both detergent and chlorine,
this reduces the need to clean equipment before disinfection.
Chlorine-based disinfectants
10,000 ppm available chlorine
When to use
10,000 ppm
On equipment that is contaminated with
blood or blood stained body fluids.
What to use Use Sodium Dichloroisocyanurate (NaDCC),
e.g., Haz-Tab, Actichlor, tablets as per
manufacturer’s instructions.
A diluter bottle should be used to ensure the
correct dilution is achieved.
Chlorine-based disinfectants
1,000 ppm available chlorine
When to use
1,000 ppm
On equipment that comes into contact with a
known or suspected infected patient, non-
intact skin, body fluids (not blood) or mucous
membranes.
What to use
Use Sodium Dichloroisocyanurate (NaDCC),
e.g., Haz-Tab, Actichlor, Chlor-Clean,
Actichlor Plus, tablets as per manufacturer’s
instructions.
A diluter bottle should be used to ensure the
correct dilution is achieved.
SAMPLE
General Practice
39 11
. Is
ola
tio
n (K
ey t
op
ic)
11. Isolation Dedicated isolation treatment rooms are not required in
General Practices, but General Practices are expected to
implement reasonable precautions when a patient is
suspected or known to have a transmissible infection, Health
and Social Care Act 2008: Code of Practice on the prevention
and control of infections and related guidance.
The implementation of standard precautions will reduce the
risk of the transmission of infection in General Practice.
However, patients with specific infections who may be a risk
to others, e.g., a child with chickenpox or a patient with
influenza during an outbreak of Pandemic Influenza, should
be segregated so that the risk of infection to other patients in
waiting or communal areas is minimised. Where possible,
arrangements should be made to see these patients in their
own home or in a separate area of the practice away from
other patients.
Preparation
Refer to your local policy on Isolation.
The designated room or area should be free from clutter
and where possible, equipment not required for the
consultation should be removed from the room.
A risk assessment should be undertaken for the personal
protective equipment (PPE) required, e.g., disposable
apron and gloves. The routine wearing of masks is usually
not required, however for certain infections, e.g., Pandemic
Influenza, Ebola, or new emerging
infections, national guidance should
be followed.
PPE should be worn and removed
correctly (see page 19).
SAMPLE
Preventing Infection Workbook and Guidance
44
Wear a disposable apron and sterile gloves.
Ensure all fluids, equipment and materials used are sterile.
Check sterile packs are within the expiry date and there is
no evidence of damage or moisture penetration.
Ensure contaminated or non-sterile items are not placed in
the sterile field.
Do not reuse single use items.
Aseptic technique competency
Only staff trained and competent in an
aseptic technique should undertake this procedure.
An ‘Aseptic technique competency assessment record’
and ‘Aseptic technique procedure audit tool’ for both
urinary catheterisation and wound dressing are available at
www.infectionpreventioncontrol.co.uk.
It is good practice to undertake peer audits to monitor
competency and a record of training and audit should be
available.
Procedure for dressing a wound using an aseptic technique
Explain the procedure to the patient.
Be ‘Bare Below the Elbows’. Decontaminate hands with
liquid soap and warm water and dry with paper towels or
use an alcohol handrub and allow to dry.
Decontaminate the dressing trolley with detergent and
warm water or detergent wipes.
Assemble dressing packs and equipment, check all items
are in date and packaging is intact.
Position patient comfortably and decontaminate hands.
Put on a disposable apron.
13
. A
sep
tic
te
ch
niq
ue
(Ke
y t
op
ic)
SAMPLE
Preventing Infection Workbook and Guidance
48
Specimens delivered by patients
Wherever possible, reception staff should avoid handling
specimens due to the risk of infection.
Specimens should be in an appropriate container.
If there is leakage or an inappropriate container is used,
the specimen should be rejected as it may not be
processed by the laboratory due to the risk of infection.
In exceptional circumstances, if a specimen is not in an
appropriate container and where transfer to the correct
container is necessary, PPE should be worn.
Specimens should be labelled correctly and all details
completed on the form and placed in the appropriate
specimen bag.
14
. S
pe
cim
en
co
llec
tio
n (K
ey t
op
ic)
Specimen Indication Container
Wound
swab
Swelling, redness, heat, a
yellow or green discharge,
increased discharge of fluid,
wound deterioration, fever.
Sterile cotton swab in
transport medium.
Charcoal medium
increases survival of
bacteria during
transportation. Store at
room temperature.
Sputum Productive cough (green or
yellow) or presence of blood
in sputum.
Plain universal container.
Store at room
temperature.
Urine Pain on passing urine,
increase in frequency, fever,
new urinary incontinence,
new or worsening confusion,
flank or lower abdominal
pain.
Universal container with
boric acid (red top) which
prevents bacteria from
multiplying in the
container.
Refrigerate.
Faeces Diarrhoea, increase in
frequency, presence of
blood, abdominal pain.
Stool specimen container
(at least 1/4 full). Store at
room temperature.
SAMPLE
Preventing Infection Workbook and Guidance
52 15
. V
ira
l g
as
tro
en
teri
tis
/No
rov
iru
s
Viral gastroenteritis is spread by:
contaminated hands of patients and staff
contaminated surfaces and equipment
contaminated food (food can be contaminated when being
prepared by an infected person with viral gastroenteritis).
Advice for patients with viral gastroenteritis
Drink plenty of fluids to prevent dehydration.
Wash hands thoroughly after each episode of diarrhoea
and vomiting with liquid soap and warm water.
If possible, infected patients should try to avoid preparing
and handling food for other people until free from
symptoms for 48 hours.
Stay at home, do not visit friends, relatives, hospitals or
care homes, until free from symptoms for 48 hours.
Disinfect toilets and surrounding area at home with a
household bleach as per manufacturer’s instructions.
Cleaning an episode of diarrhoea or vomiting at the
General Practice
1. Wear appropriate personal protective equipment (PPE), e.g., disposable apron and gloves.
2. Ventilate the area if possible by opening windows and doors.
3. Clean up vomit or diarrhoea promptly with paper towels.
4. Use a spillage kit or clean area with detergent and warm water or detergent wipes followed by a chlorine-based disinfectant at 1,000 parts per million (see page 26).
5. Dispose of waste and PPE as infectious waste.
6. Wash hands with liquid soap and warm water.
SAMPLE
Preventing Infection Workbook and Guidance
56 16
. C
los
trid
ium
dif
fic
ile
Clo
str
idiu
m d
iffi
cile
in
fec
tio
n (
CD
I) t
rea
tmen
t a
dvic
e f
or
pre
sc
rib
ers
(sh
ou
ld b
e g
ive
n in
ac
co
rda
nce
wit
h lo
ca
l a
nd
na
tio
nal
gu
ida
nce
)
Wh
en
to
tre
at
Wh
en
an
tib
ioti
cs a
re r
eq
uir
ed
No
n-s
ev
ere
CD
I: t
reat
in p
rim
ary
care
.
Mild
CD
I: n
ot associa
ted w
ith a
ra
ised W
CC
, ty
pic
ally
associa
ted
with <
3 s
tools
of
typ
e 5
-7 o
n t
he B
risto
l S
tool
Form
Scale
per
da
y.
Modera
te C
DI: a
ssocia
ted
with a
rais
ed W
CC
(<
15 x
10
9/L
),
typ
ically
associa
ted w
ith
3-5
sto
ols
per
da
y.
Revie
w p
rogre
ss d
aily
. S
ev
ere
CD
I: s
pecia
list tr
ea
tment only
. A
dm
it a
s a
n
em
erg
en
cy.
Se
vere
CD
I: a
ssocia
ted
with W
CC
>15 x
10
9/L
or
an
acute
risin
g s
eru
m c
reatin
ine
(i.e.,
50%
abo
ve b
ase
line)
or
evid
ence o
f severe
colit
is.
Life
-thre
ate
nin
g C
DI: inclu
des h
yp
ote
nsio
n, p
art
ial or
com
ple
te ile
us o
f to
xic
megacolo
n, or
CT
evid
ence o
f severe
dis
ease.
Fir
st
ep
iso
de:
Metr
on
idazo
le 4
00 m
g*
TD
S f
or
10-1
4 d
ays (
70%
of
patien
ts
respond t
o m
etr
onid
azole
in 5
da
ys;
92%
in
7 d
ays).
If n
ot
resp
on
din
g c
onta
ct lo
cal C
onsultant
Mic
rob
iolo
gis
t.
If s
eco
nd
ep
iso
de:
ora
l va
ncom
ycin
125
mg*
QD
S f
or
10
-14 d
ays o
r seek
Consultant
Mic
robio
logis
t a
dvic
e
Ple
ase n
ote
va
ncom
ycin
ca
ps 1
25 m
g
QD
S c
ann
ot b
e a
dm
inis
tere
d v
ia P
EG
. *T
he
ch
oic
e o
f a
ntib
iotic t
rea
tme
nt m
ay d
iffe
r,
ple
ase
refe
r to
yo
ur
local A
ntim
icro
bia
ls
Gu
ide
lines.
Clo
str
idiu
m d
iffi
cil
e P
resc
rib
ing
no
tes a
nd
gen
era
l a
dvic
e
Ho
w t
o r
esp
on
d t
o p
os
itiv
e l
ab
ora
tory
resu
lts
In
itia
te tre
atm
ent as in
dic
ate
d (
and isola
te the p
atie
nt if in
a n
urs
ing/c
are
hom
e).
S
top c
oncom
itant (n
on
-C.
difficile
) antib
iotics if safe
to
do s
o a
nd a
ny la
xatives. R
evie
w a
nd s
top a
ny c
oncom
itant P
PI use if possib
le. D
o n
ot
use a
ntim
otilit
y d
rugs,
e.g
., lo
pera
mid
e.
Pru
dent
antibio
tic p
rescrib
ing r
educes t
he r
isk o
f C
. difficile
in
fectio
n a
nd/o
r re
lapsin
g in
fectio
n. B
road
-spectr
um
agents
, in
part
icula
r,
should
not be p
rescrib
ed u
nle
ss there
is a
cle
ar
clin
ical need. F
or
patie
nts
with a
recent his
tory
, i.e., w
ithin
one y
ear,
of C
. difficile
, advic
e s
hould
be s
ought fr
om
a C
onsultant M
icro
bio
logis
t on a
ppro
pria
te a
ntib
iotic c
hoic
e f
or
recurr
ing C
DI.
F
aecal tr
anspla
natio
n is
undert
aken in
som
e h
ospitals
. F
urt
her
advic
e c
an b
e o
bta
ined fro
m y
our
local C
onsultant
Mic
robio
logis
t.
SAMPLE
Preventing Infection Workbook and Guidance
60
MRSA screening
In accordance with Department of Health guidance, MRSA
screening is routinely undertaken by hospitals. If a MRSA
positive result is diagnosed after a patient has been
discharged from hospital, the General Practice may be
contacted by the local Infection Prevention and Control (IPC)
or Public Health England (PHE) team to discuss the need for
decolonisation treatment.
If MRSA screening is to be undertaken at the General
Practice, swabs should be taken in accordance with local
policy. The sites to be swabbed usually include nose and any
vulnerable sites, e.g., wound, and if a urinary catheter is
in-situ a catheter specimen of urine should also be taken.
17
. M
RS
A
How to take a nasal swab for MRSA screening
Wash hands and apply non-sterile gloves.
Place a few drops of either sterile water or
sterile normal saline onto the swab taking
care not to contaminate the swab.
Place the tip of the swab inside the nostril at
the angle shown.
It is not necessary to insert the swab too far
into the nostril.
Gently rotate the swab ensuring it is touching
the inside of the nostril.
Repeat the process using the same swab for
the other nostril.
Place the swab into the container.
Dispose of gloves and wash hands.
Complete patient details on the container
and specimen form. Request ‘MRSA
screening’ under clinical details on the form.
SAMPLE
Preventing Infection Workbook and Guidance
66
It’s a fact
The toxin was first described by Panton and Valentine in 1932.
A PCR test for PVL virulence genes and simultaneous discrimination of MRSA from MSSA has recently been developed. The unit at Colindale can provide a result within the working day.
Use a clean designated towel which should be kept
separate, to avoid use by other people. The towel should
be washed frequently on a hot wash cycle, e.g., 60oC.
Regularly vacuum and dust with a damp cloth all rooms
including personal items. A household detergent is
adequate for cleaning.
Clean the wash basin, taps and bath after use with
household detergent and a disposable cloth.
Cover nose and mouth with a tissue when coughing or
sneezing, because PVL-SA can live in the nose.
Immediately dispose of the tissue and then wash hands
with liquid soap and warm water.
If you are a carer in a nursery, hospital, care home or work
in the food industry, e.g., chef, waitress, you should not
return to work until the lesion has healed.
Do not visit a gym or take part in contact sports until all
lesions are healed.
18
. P
VL
– S
tap
hy
loc
oc
cu
s a
ure
us
Test your knowledge Please tick the correct answer True False
1. PVL-SA can cause recurrent boils or skin
abscesses.
2. PVL-SA can be spread by using shared
towels and shared razors.
SAMPLE
Preventing Infection Workbook and Guidance
72
It’s a fact
Identification of CPE in England by the Public Health England National Reference Laboratory has risen from fewer that 5 patients reported in 2006 to over 600 in 2013.
The resistant CPE bacteria produce an enzyme (carbapenemase) that breaks down the antibiotic and makes it ineffective.
Note
Patients found to be positive for
CPE either colonised or infected,
should have been given advice
about CPE and a CPE card. The
card should be shown to healthcare providers involved in
their care. For further details visit
www.infectionpreventioncontrol.co.uk
20
. C
PE
Remember
Using standard precautions will minimise the spread of
CPE and should be rigorously implemented, but no
additional infection control precautions are required.
Seek advice from your local Community Infection
Prevention and Control or Public Health England team if
required.
Test your knowledge Please tick the correct answer True False
1. There are very few antibiotics for the
treatment of CPE infections.
2. It is not necessary to undertake hand
hygiene when dealing with a CPE patient.
SAMPLE
Preventing Infection Workbook and Guidance
74
Key references British Medical Association (May 2012) CQC Registration—What you need to know, Appendix B
Policies and Protocols Guidance for GP Available at www.bma.org.uk. [Accessed 07/07/15]
Care Quality Commission Homepage [online] Available at www.cqc.org.uk. [Accessed 14/07/15]
Department of Health (July 2015) The Health and Social Care Act 2008: Code of Practice on the
prevention and control of infections and related guidance
Department of Health (June 2015) Toolkit for managing carbapenemase-producing
Enterobacteriaceae in non-acute and community settings
Department of Health (2013) Health Technical Memorandum 07-01: Safe management of
healthcare waste
Department of Health (January 2009) Clostridium difficile infection: How to deal with the problem
Harrogate and District NHS Foundation Trust (May 2015) Community Infection Prevention and
Control Guidance for Health and Social Care
Health Protection Agency (November 2011) Guidelines for the management of Norovirus
outbreaks in acute and community health and social care settings
Health Protection Agency (November 2008) Guidance on the diagnosis and management of PVL-
associated Staphylococcus aureus infection (PVL-SA) in England 2nd Edition
Healthcare Commission (October 2007) Investigation into outbreaks of Clostridium difficile at
Maidstone and Tunbridge Wells NHS Trust
Loveday HP, et al, epic3: National Evidence-Based Guidelines for Preventing Healthcare-Associated Infections in NHS Hospitals in England Journal of Hospital Infection 86S1 (2014) S1–S70
Medicines and Healthcare Products Regulatory Agency (April 2015) Managing Medical Devices
Guidance for healthcare and social services organisations Available at www.gov.uk/government/
publications/managing-medical-devices. [Accessed 22/07/15]
Mid Staffordshire NHS Foundation Trust (2013) The Report of the Mid Staffordshire NHS
Foundation Trust Public Inquiry volume 2: Analysis of evidence and lessons learned (part 2),
Chaired by Robert Francis QC 2013
National Institute for Health and Care Excellence (August 2015) Antimicrobial stewardship:
systems and processes for effective antimicrobial medicine use Available at www.nice.org.uk/
guidance/ng15/resources. [Accessed 19/08/15]
National Institute for Health and Clinical Excellence (2012) Infection: prevention and control of
healthcare-associated infections in primary and community care Clinical Guideline 139
National Patient Safety Agency (August 2010) The national specifications for cleanliness in the
NHS: Guidance on setting and measuring performance outcomes in primary care medical and
dental premises
Public Health England (2013) Immunisation Against Infectious Disease (The Green Book) Available at www.gov.uk/government/collections/immunisation-against-infectious-disease-the-green-book. [Accessed 06/07/15]
Royal College of Nursing (April 2014) The Management of waste from health, social and personal
care RCN guidance
Royal College of Nursing (January 2012) Essential practice for infection prevention and control
Royal College of Nursing (2012) Tools of the trade: RCN guidance for health care staff on glove
use and the prevention of contact dermatitis
Royal Marsden (March 2015) The Royal Marsden Hospital Manual of Clinical Nursing Procedure
9th Edition [online] Available at www.rmmonline.co.uk. [Accessed 14/07/15]
Ke
y r
efe
ren
ce
s
SAMPLE
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76
Written and produced by Community Infection Prevention and Control
Harrogate and District NHS Foundation Trust
Tel: 01423 557340
www.infectionpreventioncontrol.co.uk
August 2015
© Harrogate and District NHS Foundation Trust, Community Infection Prevention and Control 2015
SAMPLE
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