Infection Prevention and Control in General Practice
Page Contents
| CQC | Local ICB/ICS Support |
| Legionnaire | Sepsis |
| National Standards of Healthcare Cleanliness | Covid 19 - Latest Guidance |
| Useful Resources | Training Resources |
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 23/12/2022, 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
- 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.
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 / daniel.smith35@nhs.net
Dorset - QIT@nhsdorset.nhs.uk
Frimley - TBC
Hampshire & the Isle of Wight - hiowicb-hsi.infectionprevention@nhs.net
- Isle of Wight - Lesley Barclay lesley.barclay1@nhs.net 07385 401015
- North and Mid Hampshire - Becky Cave rebecca.cave3@nhs.net 07500 063954
- Southampton City - Sue Kingsbridge and Heidi Crumpton
sue.kingsbridge@nhs.net, 07584114743 heidi.crumpton3@nhs.net 07765171895 - South Eastern Hampshire - Charmaine Donnelly
charmaine.donnelly1@nhs.net 07825866995 - South West Hampshire - Natalie Hallowell n.hallowell@nhs.net 07919306473
- Portsmouth City - Currently provided by Solent Trust, however the 7-day service can also provide support hiowicb-hsi.infectionprevention@nhs.net 08703156601
- ICB IPC Lead (community) - Viv O'Connor
vivienne.oconnor@nhs.net 07876858584
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
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
- Appropriate emergency equipment and medicines accessible for the treatment of patients with possible sepsis, including pulse oximeters for adults and children and staff aware of the Patient Safety Alert for placement of pulse oximeter probes
- 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.
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.
National Standards of Healthcare Cleanliness
According to the CQC (updated 23/12/2022) - 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.
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.
Cleanliness in General Practice podcast
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.
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
Useful Resources
Norovirus guidance sheet - with special thanks to Daniel Smith from BSW ICB.
Role and Responsibilities of the IP&C Lead in Primary Care - with special thanks to Tina Arnold and team at Dorset ICB.
- Environmental Cleanliness Audit Tool for General Practice
- IPC - IPC Bulletin for GP Practice Staff - To further support GP Practice Staff, the Bulletins contain information on good infection prevention and control (IPC) practice and research from some of the latest CQC Inspection Reports. They cover top IPC tips for good practice and pre-CQC visit recommendations.
- IPC - Infection Prevention Control - CQC Compliance
- IPC - Infection Prevention Control - Policies for General Practice
- e-Learning for Healthcare
- NHSE - Supporting excellence in infection prevention and control behaviours: Implementation Toolkit
- RCN - Infection Prevention and Control - Subject Guide
- The Health and Social Care Act 2008: Code of Practice on the prevention and control of infections and related guidance.
- NHS England Resources - National Infection Prevention and Control
- Products - Antimicrobial stewardship | Topic | NICE
- NHS - What should I do if I injure myself with a used needle?
- Gov.uk - Sharps Injuries
- Leaflets to discuss with patients: Self-care Leaflet (rcgp.org.uk)
- NHS England - Best Way to Wash Your Hands
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.
Attention all IPC leads across the Wessex region!
Primary care Infection Prevention and Management Summer Sessions
BSW ICB are pleased to announce that following on from the success of last year’s IP&C sessions there will be a further three-part series this summer.
The IP&M Summer Sessions are aimed at GP practices IP&C leads, GP partners and Practice managers and will be covering topics such as:
- Chain of infection
- National Cleanliness Standards
- IP&C and the environment
- Implementing the National Infection Prevention manual (NICPM)
- Audits
- Risk assessments
- Preparing for CQC
- Communicable disease
- Minor surgery in primary care
- Healthcare Associated Infections
- Antimicrobial Stewardship
- Supporting migrant health- IP&C view
- IP&C and sustainability- reducing your carbon footprint.
- Screening and immunisations
There will be a number of guest speakers including national, local and regional experts.
Summer sessions series will be via MS Teams on the following dates:
- Day1: June 29th 2pm-5pm
- Day 2: July 27th 2pm-5pm
- Day 3: August 24th 2pm-5pm
To book or for further information please email the BSW ICB IP&C Team Bswicb.ipc.covid@nhs.net
Although this series is being run by BSW ICB, they have kindly agreed to open this up to all practices across the Wessex region. (With special thanks to Connie Timmins IP&C lead for BSW ICB).
