Guidance

Infection Prevention and control (IP&C) is one of the major areas in the provision of safe care within any health care setting, Effective prevention and control of infection must be part of everyday practice and be applied consistently by everyone CQC.

CQC

CQC expect all providers of healthcare and adult social care to meet or exceed the expectations outlined in The Health and Social Care Act 2008: Code of Practice on the prevention and control of infections

The CQC  – general requirements, updated 9 October 2023, expect each practice to have: –

  • Effective IPC policies – accessible to all and regularly updated
  • Policy for high-risk procedures, such as minor surgery
  • An IPC lead with overall responsibility for IPC
  • Contact details of local IPC specialist team, please see below & Find your local Health Protection Team here
  • IPC audit programme, with evidence of action planning and how these issues were addressed.
  • Staff training requirements and frequency of training updates.
  • Cleaning contractors- schedule of general cleaning, should include frequency of specific areas, fixtures, and fittings, including high touch points. Policy outlining responsibilities for cleaning of specific clinical equipment
  • Access to occupational health services- staff immunisations as outlined in the Green Book , sharps injury policy.

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Local ICB/ICS Support

It is advised that practices contact their local IPC leads for their ICB/ICS for support with any queries and for up to date IPC guidance and resources.

Bath and North East Somerset, Swindon, and Wiltshire – connie.timmins@nhs.net / bswicb.ipc@nhs.net

Dorset – QIT@nhsdorset.nhs.uk

Frimley – TBC

Hampshire & the Isle of Wight – hiowicb-hsi.infectionprevention@nhs.net

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Legionnaire

Legionnaires’ disease is a lung infection you can get from inhaling droplets of water containing bacteria that causes the infection, it’s uncommon but it can be very serious. You can get legionnaires disease from things like air conditioning systems, humidifiers, spa pools and hot tubs, taps and showers that are not used often NHS.UK

The CQC expect GP practices to provide assurance that they have carried out risk assessments to identify all risks associated with their premises and that they are managing these risks. All systems require a risk assessment, but not all systems will require elaborate control measures. Neither CQC nor HSE make any requirements about who carries out the risk assessment other than that they should be competent to carry out the task.

HSE provide information to help employers and those with responsibility for the control of premises, including landlords, understand what their duties are and how to comply with health and safety law. More information can be found here around practical advice on the legal requirements of the Health and Safety at Work etc Act 1974, the Control of Substances Hazardous to Health Regulations 2002 concerning the risk from exposure to legionella and guidance on compliance with the relevant parts of the Management of Health and Safety at Work Regulations 1999.

More information can be found here- Wessex LMCs: Health & Safety – Legionella

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Sepsis

Sepsis is a potentially life-threatening condition, triggered by infection. It can be difficult to spot but kills at least 48,000 people a year in the UK. For many patients, if sepsis is caught early, it can be easy to treat. There are lots of possible Symptoms , that can be like other conditions, such as flu or a chest infection. Anyone with an infection can get sepsis, but there are some groups that are more susceptible, and steps to prevent infection , such as vaccination, personal hygiene, seeking timely medical care of wounds and taking any prescribed antibiotics correctly, are important in the prevention of sepsis.

All patients who have any of the high-risk criteria for sepsis should be transferred to hospital immediately using the 999 response. Practitioners should make it clear at handover to the ambulance service they have high risk criteria for sepsis, in line with NICE guidance, alongside the patient’s physiological measurements to aid early identification and treatment (CQC)

CQC expect GP practices to take measures to help manage the risks associated with sepsis, this includes-

  • Sufficient training of staff (including receptionists) to recognise the signs of sepsis and raise concerns, and appropriate training in the response to acutely unwell or deteriorating patients who may have sepsis
  • Access to appointments and triage for acutely unwell patients with a process to identify and rapidly respond to possible cases of sepsis.
  • Appropriate emergency equipment and medicines accessible for the treatment of patients with possible sepsis, including oxygen cylinders accessible to provide oxygen therapy, pulse oximeters for adults and children, including staff awareness of the patient safety alert regarding placement of probes. Full guidance on  resuscitation for GP surgeries can be found here.
  • Ensuring a high uptake of immunisations, particularly flu vaccines in those in the high-risk categories
  • Systems of ‘safety netting’ are in place, including relevant follow -up care
  • Use of sepsis assessment and audit tools, consider auditing the management of patients referred to secondary care and records of any SEA and learning events and how improvements to care have been made.
  • Effective record keeping and sharing of information around a patient’s condition, including accurate physiological measurements
  • Evidence of good Infection Prevention and Control processes
  • Availability of Information and advice on sepsis for patients and carers, Perhaps on the practice website. Patient information and support is available from the sepsistrust.org.
Sepsis Useful Resources

The UK Sepsis Trust have professional resources on their website and training resources can be found in the RCGP Sepsis Toolkit .

This link to our Wessex LMCs Lunch & Learn can be shared with the whole practice team to improve awareness and management of sepsis and deterioration.

SEPSIS SAVVY

This educational video from The UK Sepsis trust, features Bafta Award wining actor Jason Watkins who lost his daughter Maude from sepsis at the age of just 2 and a half years old.

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National Standards of Healthcare Cleanliness

According to the CQC (updated 09/10/2023) – the National Standards of Healthcare Cleanliness 2021 replace the 2007 specifications for NHS cleanliness. This guidance mirrors expectations for GP providers which are already covered by our regulations and the code of practice. For example, IPC audit processes, waste management, cleaning schedules and maintenance of equipment.

There are no expectations that we require star ratings or logos to be displayed in general practices. We will continue to regulate using Regulations 12  and 15 . We will also regulate using the code of practice on prevention and control of infection.

The Health and Social Care Act 2008:code of practice on the prevention and control of infection was updated 13th December 2022, to reflect the structural changes that took effect in the NHS from 1 July 2022 and the role of IPC (including cleanliness) in optimising antimicrobial use and reducing antimicrobial resistance, full document can be found here.

Wessex LMCs has approached the BMA for their stance on the implementation of the standards into primary care-

The BMA (October 2022) advise that there remains no legal or contractual obligation for GP practices to implement the National Standards of Healthcare Cleanliness. Practices should continue to adhere to the advice outlined by CQC .

Practices may choose to implement the standards in some shape or form to demonstrate compliance to the regulations set out by CQC, this would be considered good practice by some of the local ICB Infection prevention and control leads, who have developed resources and templates that practices can adapt and use, please see resources below.

National Standards of Healthcare Cleanliness Podcast & Resources

Recorded during our PM update on 31st August, Connie Timmins, Lead Nurse for Infection Prevention and Control at NHS BSW ICB talks to us about the National Standards of Healthcare Cleanliness 2021.

 

Podcast

Webinar version

National Standards of Healthcare Cleanliness Presentation Slides 

Wessex LMCs National Standards of Healthcare Cleanliness 2021

BSW CCG Primary Care NHS National Cleanliness Standards

HIOW National Standards of Healthcare Cleanliness 2021 – a guide for Primary Care

Primary Care CCG Cleaning Audit Score Sheet

With special thanks to Connie Timmins from BSW ICB and Viv O’ Connor and team from HIOW ICB, who have provided us with the following resources that they are happy to share for practices to use to help with the implementation of the standards.

infectionpreventioncontrol.co.uk

Cleanliness in General Practice Podcast

Click here to listen.  Wessex LMCs Practice Nurse Advisor, Zoe Tobin, talks with Will Mckenzie from Smart Group Services, who works with a number of practices across Wiltshire and Hampshire to discuss top tips for practices in optimising their working relationship with external cleaning companies to ensure compliance to IPC policy and aid the audit process.

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Clinical Waste

Clinical waste update

The Health Technical Memorandum 07-01: Safe and sustainable management of healthcare waste (england.nhs.uk)– (updated March 2023) is a framework for best practice. It makes sure that legislation such as Health and Safety at Work regulations are met.

Key changes to the March 2023 update:

  • Focus on Tiger strip bags rather than orange bags- SRCL will be slowly phasing these in.
  • The requirement to dispose of sharps bins after 3 months of opening regardless of whether they are full or not has disappeared from the document.
  • Couch roll now goes into the tiger stripe bags (Previously could be disposed of in the domestic waste if not contaminated).

Taken from the HIOW ICB update, many thanks to Viv O’Connor and her IPC team for allowing us to share this summary of the key changes.

Clinical waste Audits

Since the introduction of the Environment Agency (EA) guidance for waste management companies in 2007, there has been a change in the way that healthcare waste is regulated in England and Wales. All healthcare waste producers, including GP practices, must provide audits of their waste to their waste management contractors if they are to continue to have their waste accepted at a clinical waste alternative treatment facility. The treatment facilities are required by their permits to obtain additional detailed information on the composition of a waste before they receive it, which forms part of their ‘pre-acceptance’ checks.  This audit is an Environmental Agency legal requirement and failure to provide an audit report could result in the EA prohibiting waste collecting companies from collecting the waste from GP practices.

The Environmental Civil Sanctions (England) Order 2010 came into force on 6 April 2010 and gives the EA the power to invoke civil sanctions, such as monetary penalties, if companies do not comply with the environmental laws.

More information on clinical waste is available from the BMA (including a self- audit tool) & the CQC.

Audit tools and resources

NHS England » National infection prevention and control

NHS England » National infection prevention and control manual for England – appendices

Infection Prevention Control – Audits

National Standards of Healthcare Cleanliness 2021 for General Practice – Infection Prevention Control

Safe disposal of waste (infectionpreventioncontrol.co.uk)

Classify different types of waste: Healthcare and related wastes – GOV.UK (www.gov.uk)

 

Correct Sharps Disposal Poster 

 

 

 

 

 

Waste stream guide Poster for General Practice

 

 

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Covid 19 – Latest Guidance

In June 2022 – NHSE issued a letter updating the IPC Guidance.

In March 2023 the UKHSA updated its UK IPC guidance for COVID-19: information and advice for health and care professionals with COVID-19 pathogen-specific advice for health and care professionals. This advice should be read alongside the National Infection Prevention and Control Manual (NIPCM) for England and applies to all NHS settings or settings where NHS services are delivered.

The key message –

In health and care settings, non-pharmaceutical interventions (such as mask-wearing and enhanced ventilation) are used, depending on local prevalence and risk assessment, to help to reduce the spread of SARS-CoV-2. More information on local cases can be found here – Interactive map of cases | Coronavirus in the UK (data.gov.uk)

BSW ICB have produced a Mask use RAG tool to aid practices with risk assessment and implementation at practice level, this would coincide with looking at the local case rate (using interactive map from UKHSA above) and review of the calls coming through to the surgery and staff sickness and utilise the tool to make an informed decision (with special thanks to Connie Timmins, IPC lead for BSW who has given us permission to share this tool with practices across the Wessex patch).

Transmission-based precautions should only be discontinued in consultation with clinicians and should take into consideration the individual’s test results as well as resolution of clinical symptoms.

The BMA and RCN provide further information on PPE and Covid 19, including workplace risk assessment toolkits.

The UKHSA have updated their guidance Managing healthcare staff with symptoms of a respiratory infection or a positive COVID-19 test result – GOV.UK (www.gov.uk) on 31st March 2023, key changes include-

  • most healthcare staff who have symptoms of a respiratory infection are no longer asked to test for COVID-19
  • healthcare staff who test positive for COVID-19 are no longer required to have 2 negative lateral flow device (LFD) tests for COVID-19 before they return to work
  • healthcare staff whose job primarily involves providing direct care to inpatients who are severely immunosuppressed, such as those working in inpatient areas for solid organ, stem cell or bone marrow transplant or haemato-oncology patients, should take an LFD test if they develop symptoms of a respiratory infection, in line with locally decided protocols
  • healthcare staff whose job primarily involves providing direct care to inpatients who are severely immunosuppressed and who have a positive COVID-19 test should return to work in line with locally decided protocols

Key summary of points for healthcare staff who are not providing direct inpatient care to those who are severely immunosuppressed-

  • Those staff who with symptoms of a respiratory infection and are unwell are advised to stay home and avoid contact with people, they do not have to take a test. They should stay home until they no longer feel unwell, or they no longer have a temperature (if they had one)
  • If staff members have a positive Covid-19 test result they should stay home for 5 days after the day, they took the test.
  • Line managers should then undertake a risk assessment before patient facing staff return to work ( this would include reception teams)
  • If staff return to work, they must comply rigorously with ALL IP&C measures .

It is thought that individual practice will have to make their own assessment of risk that they are willing to accept in terms of how they implement the national guidance, taking into account factors such as staffing levels, overall patient population and environment in which they work. Further local advice and support maybe available from your local ICB IPC leads (contacts can be found above).

Provision of PPE –

On 10 January 2023, the government announced its decision to extend the central, free provision of Covid PPE to the health and care sector, by up to one year to March 2024 or until stocks are depleted (whichever is sooner). The scheme will provide protection for frontline staff against Covid as part of the government’s Living with Covid strategy. DHSC will publish details about stock-out dates by PPE category by April 2023. Further information about the extension and the scheme can be found on the DHSC website

Please note-

We are aware that this offer has now expired. As the PPE portal was originally set up in response to the COVID-19 pandemic, in order to meet the demand of much needed PPE for primary care, social care and public sector organisations, the provision of free PPE supply has now ended as of the 31st March, and the portal will close on the 23rd May 2024. 

We are currently awaiting further guidance on how PPE will be procured at local level, so watch this space! In the absence of this, practices will need to secure their own supply.

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Training Resources

Available via the National PPE online learning portal – here

(Requires sign up but all modules are free)

 

 

New NHSE IP&C Education framework March 2023 –  available here The framework will be used by the national IPC programme to develop and commission a new national programme of IPC mandatory training.

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Last Reviewed Date
13/05/2024