Infection Control in General Practice
Infection control is one of the major areas in the provision of safe care within any health care setting. It is also one of the priorities in any CQC inspection under Regulation 12 of the, Safe care and treatment, of the Health and Social Care Act 2008. There is a need for practices to be compliant with regulations and it is worth reading the following documents as they are the ones practices will be assessed against by CQC.
- The Health and Social Care Act 2008: Code of Practice on the prevention and control of infections and related guidance.
- The National Specifications for Cleanliness in the NHS: Guidance on setting and measuring performance outcomes in primary medical and dental care premises This includes some examples that practices can adapt and use
- Management and disposal of health care waste
The CQC will except each practice to have: -
- a named lead for Infection Control (IC)
- an up to date IC policy
- evidence of an annual IC audit
- IC lead will need to provide evidence of recent IC training including
- staff training around hand washing
- all staff should understand the importance of IC, including
- handling of specimens
- waste management
- what do if there is a needle stick injury
- appropriate management, storage and disposal of sharps
- how to dispose of urine specimens
- cleaning of equipment, including rooms
It is advised that practices make contact with the IC leads at the CCG for up to date advice and guidance on IC, for example West Hampshire CCG have an excellent website.
All staff in general practice should be aware of how to detect signs of deterioration and sepsis in patients and it is an area that the CQC will ask questions. 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.
Legionnaire's Disease is a potentially deadly disease caused by the legionella organism. The organisms can live in water systems used for air conditioning, showers, and cooling systems. Like with all the other risk assessments practices make on a regular basis, it should be a consideration but there is no mandatory requirement* or system for this so far.
*Legal point of clarification - there is no mandatory requirement to employ an agency to do a legionella risk assessment. The need for practices to do a "suitable and sufficient" risk assessment is covered under the Health and Safety at Work Act 1974 section 4 (duties of Landlords and those in control of premises). To comply with this act there is a need to (among other things) take account of the approved HSE code of practice L8
This leaflet Legionnaire's Disease - a guide for employers , produced by the HSE (Health and Safety Executive) is informative and will enable most practices to feel confident that they know enough to make a reasonable judgement and risk assessment.
(Taken from West Hampshire CCG - Water Safety (Legionnaires' Disease) in Primary Care)
Primary Care practices have a duty to ensure that their water systems do not pose a risk to the health and safety of employees and visitors (e.g. patients, hosted staff and contractors) from Legionella bacteria under the Control of Substances Hazardous to Health Regulations (COSHH) and the Health & Safety at Work Act.
The Care Quality Commission (CQC) also expects practices to fulfill these obligations to demonstrate compliance with the essential standards of quality and safety (Outcome 8: cleanliness and infection control and Outcome 10: safety and suitability of premises).
All water systems in Primary Care practices require a risk assessment. However not all systems will require elaborate control measures and responses and actions should be proportionate to the identified risk. A simple risk assessment may show that the risks are low and being properly managed to comply with the law. It is likely to that most practices will not require anything more than a basic local risk assessment and simple in-house control measures.
This document (Water Safety Pseudomonas and Legionella) is a summary designed to introduce Primary Care practices to the requirements around water safety and help practices determine whether external consultation is proportionate and necessary.
Useful Web Links
Useful Resources, Information and Advice on Training
Controlled Substances Hazardous to Health (COSHH)
NHS England - Best Way to Wash Your Hands
Medical Protection - Risk Alert: Infection Control
Needle Stick Injury
Gov.uk - Sharps Injuries
Managing Common Infections
Wessex LMCs - Antibiotic Prescribing in the Community
Microguide - The South Central Antimicrobial Network (SCAN) Guidelines for Antibiotic Prescribing in the Community provide advice on the effective and safe treatment of infections commonly presenting in primary care and are based on NICE and Public Health England advice with input from local experts.
NHS Wales - Treating your infection