IC-Y1
WALSALL HOSPITALS NHS TRUST
SECTION 1 Policy Lead Director: Director of Infection Prevention and Control
Policy Lead:
Infection Control Doctor
Ratification Group:
Quality Committee
Minute number:
209.07/01/02
Review date:
September 2009
SECTION 2 Standard Infection Control Precautions - Hand Hygiene and Personal protective equipment
SECTION 3
Summary
This policy outlines the importance of hand hygiene and the use of personal protective
clothing by all staff working within Walsall Hospitals NHS Trust, to reduce the risk of cross
infection.
SECTION 4
Index
1.0
Introduction
2.0
Aim
3.0
Objective
4.0
Definitions
5.0
Roles and Responsibilities
6.0
Standard principles for hand hygiene
7.0
Standard principles for the use of personal protective equipment
8.0
Gloves
9.0
Aprons and gowns
10.0
Facial protection
11.0
Associated policies
12.0
Monitoring, control and audit
13.0
References
1.0
INTRODUCTION
1.1
It is impossible to identify all patients who are either colonised with bacteria or carriers of blood
borne viruses. It is therefore the recommended approach to assume that all patients are potential
carriers of pathogenic organisms (DH 1990). The same basic level of precaution must therefore be
taken with ALL patients, thus minimising the potential for infection transmission.
There are eight key elements to standard precautions all of which when appropriately implemented
are designed to reduce risk of transmission of micro-organisms, they are:
Hand hygiene
Personal protective equipment
Sharps Disposal
(Refer to IC-Y3 Safe Handling and disposal of Sharps)
Waste Disposal
(Refer to IC-Y2 Safe handling of Clinical Waste policy)
Linen Handling and segregation
(Refer to IC-Y5 Safe management of Linen) Blood and body fluid spillage procedure
(Refer to IC-Y4 Safe management of blood and
body fluid spillages)
Handling and transport of specimens
(Refer to IC-O9 Laboratory specimens)
Decontamination of equipment and the environment
. (Refer to policy IC-P1
Decontamination of medical devices)
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2.0
AIM
The aim of this policy is to provide specific guidance to Walsall NHS Trust staff on the correct
practices to undertake in order to reduce the risk of cross infection.
3.0
OBJECTIVE
The specific objectives of this policy are:
To ensure compliance with national evidence based practice
To ensure that staff and patients are protected from the risk of infection by adopting good
practice
To comply with Health and Safety regulations.
4.0
ABBREVIATIONS
For the purpose of this document the following abbreviations will be used:
A&E Accident and Emergency
DH Department of Health
TB Tuberculosis
SARS Severe Acute Respiratory Syndrome
5.0
ROLES AND RESPONSIBILITIES
This policy applies to all staff groups including Agency, locum, visitors and others.
Executive/Senior Management
The Chief Executive is responsible for the effective implementation of this policy.
Executive and Senior Managers are required to be familiar with the contents of the policy and
support its implementation throughout the organisation, including agency and contracted
personnel. They are also responsible for ensuring that there is adequate training provided within
the Trust to support the implementation of this policy.
Clinical Directors/Divisional Directors/Senior Nurses are responsible for implementing this
policy and for facilitating training and audit within their areas of responsibility.
Healthcare workers (Professional and Support Workers). All clinical staff are required to be
knowledgeable of the contents of the policy and participate in implementing its recommendations
into their working practices. Clinical staff also have a responsibility towards the safer working
practices of students, trainees etc in their care.
Non-Clinical staff. All non-clinical staff are required to have an awareness of this policy and how
it affects them as employees within a clinical organisation.
6.0
STANDARD PRINCIPLES FOR HAND HYGIENE
Hand washing has been repeatedly demonstrated to be the most important action healthcare
workers can take in preventing the spread of infection. Patients are put at potential risk of
developing a healthcare associated infection when a health care worker caring for them, has
contaminated hands.
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6.1
When to decontaminate your hands
• Hands must be decontaminated immediately before each and every episode of direct
patient contact/care and after any activity or contact that potentially results in the hands
becoming contaminated.
• Hands that are visibly soiled or potentially grossly contaminated with dirt or organic matter
must be washed with liquid soap and water.
• Apply alcohol based hand rub or wash hands with liquid soap and water to decontaminate
hands between caring for different patients or between different caring activities for the
same patient.
6.2
Types of hand decontamination
Social hand washing
Hands that are visibly soiled or potentially grossly contaminated with dirt or organic material must
be washed with liquid soap and water.
Hygienic hand washing
The use of anti-microbial liquid soap preparation (e.g. Chlorhexidine) will reduce the numbers of
transient microorganisms and resident flora, and result in hand antisepsis.
Surgical hand decontamination. This aims to significantly reduce resident microorganisms and remove transient microorganisms.
This process is achieved by using an antiseptic hand cleanser (e.g. Chlorhexidine or Povidine
iodine) and prolonged washing technique.
NB: When caring for patients with Clostridium difficile or diarrhoea hands must always be
decontaminated using Chlorhexidine.
Table 1: A guide to hand decontamination is required (Hospital Infection Society 2001)
Type
Examples
Hand washing agent
Social
• Before and after any patient contact
Mild liquid Soap
• On entering and before leaving ward/
• department.
• Before handling or eating any food/drinks
• After removing gloves
• After using the toilet.
• If the hands are visibly soiled.
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Hygienic
• After removal of any protective clothing
Soap and water followed by
• Prior to insertion or manipulation of any
alcohol hand rub
invasive devices.
• Before and after wound dressings
Or
• Before leaving isolation room
• During an outbreak
Chlorhexidine hand wash.
• Before care of immune suppressed patient
• After handling body fluids.
• After dealing with soiled linen
• Between patients in high-risk areas.
Surgical
Prior to surgical procedures
Chlorhexidine or Povidine -
iodine
6.3
Hygienic hand gels (also referred to as Alcohol gel)
When decontaminating hands using an alcohol hand rub:
• Hands must be free of dirt and organic material.
• The hand rub solution must come into contact with all surfaces of the hands.
• The hands must be rubbed together vigorously, paying particular attention to the tips of the
fingers, thumbs and the areas between the fingers, until the solution has evaporated and the
hands are dry.
Alcohol gel is provided in a number of ways throughout the clinical areas in the Trust. They come
as:
• Wall mounted dispensers at ward entrances, outside side rooms and other key areas.
• Pump action bottles at the bedside and on trolleys.
• Personal carrier dispensers that can clip to one’s clothing.
NB: Alcohol hand gel is not effective against Clostridium difficile spores.
6.4
Hand washing technique
Effective hand washing technique involves three stages: preparation, washing and rinsing, and
drying.
• Preparation requires wetting hands under tepid running water
before applying liquid soap
or anti-microbial preparation.
• The hand-wash solution must come into contact with
all the surfaces of the hands.
• The hands must be
rubbed together vigorously for a minimum of 10-15 seconds, paying
particular attention to the tips of the fingers, the thumbs and the areas between the fingers.
• Hands should be rinsed thoroughly prior to drying with good quality paper towels
Appendix 1 highlights the hand wash technique to be used for decontamination of hands (as
recommended by the Infection Control Nurses Association).
6.5
Rings and wrist watches
Stoned rings and wrist watches harbour bacteria (Larson 1985) and can hinder the hand washing
process. Stoned rings can also make it more difficult to put on gloves. Ideally hand and wrist
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jewelry should be removed before undertaking clinical procedures (Epic2 2007) Staff must also
adhere to the Trusts Uniform policy.
6.6
Fingernails, nail polish and artificial nails.
Artificial fingernails must not be worn in the clinical setting as:
• They can lead to an increased growth of gram negative bacteria underneath the fingernail –
which can be transferred to the patient (Pottinger
et al., 1989)
• Cracks and chips in nail polish can harbour bacteria.
• Short nails are preferable as bacteria can collect under and around fingernails.
• Gloves may tear and are harder to put on if the fingernails are long.
• Artificial nails may discourage correct hand washing technique (Larson 1989)
6.7
Skin care
• Maintain intact skin as far as possible
• Always wet hands prior to applying soap/antiseptic agent
• Always rinse and dry hands thoroughly
• Apply hand cream regularly
• Always cover cuts and abrasions with an impermeable waterproof dressing
6.8
Hand cream
• Apply an emollient hand cream regularly to protect skin from the drying effects of regular
hand decontamination. If any of the hand hygiene products cause skin irritation, contact the
Occupational Health Department for advice.
• Hand cream dispensers are available in clinical areas across the trust.
• Use of communal pots of hand cream is
not recommended.
7.0
STANDARD PRINCIPLES FOR THE USE OF PERSONAL PROTECTIVE EQUIPMENT
The selection of protective equipment is based on risk of transmission of micro-organisms to the
patient, and the risk of contamination of health care workers clothing and skin by patients’ blood,
body fluids, secretions and excretions.
Protective clothing consists of gloves, aprons, masks and eye protection. The purpose of
protective clothing is to protect staff and reduce the risk of opportunities for transmission of
microorganisms.
Under Health and Safety legislation the Trust has a responsibility to ensure staff have access to
appropriate protective clothing. Staff have a responsibility to wear protective clothing provided.
8.0
GLOVES (Also refer to Occupational health policy OC11 – Glove Usage Policy)
The main indications for the use of gloves are:
To protect the hands from contamination with organic matter or microorganisms.
To reduce the risk of transmission of microorganisms to patients and staff.
To protect hands from injury/hazardous substances.
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It is important to choose the right glove for the right task. (See Appendix 2)
•
The use of gloves should never be viewed as a substitute for appropriate hand
washing.
• Gloves are not necessary for transporting patients between departments unless there is a
risk of exposure to blood or body fluids (other than sweat).
• Gloves must be changed between caring for different patients and between different care
activities for the same patient.
• Gloves must be worn for invasive procedures, contact with sterile sites and non intact skin,
mucus membranes and all activities where there is a risk of exposure to blood and body
fluids, and when handling sharp or contaminated instruments.
• Gloves should be put on immediately before an episode of patient contact or treatment and
removed as soon as the activity is complete
• Gloves should be worn as single use items; they should not be washed or exposed to
alcohol rubs or gels.
• Gloves must be disposed of as clinical waste and hands washed following removal.
• Double gloving may be indicated where there is a high risk of glove puncture
9.0
APRONS/GOWNS
The aims of wearing a plastic aprons is to: -
• Prevent contamination of uniform/clothing
• Prevent spread of organisms via contaminated uniform/ clothing
• Prevent uniform from getting wet
• Aprons should be worn for all direct patient contact (where there may be exposure to blood
or body fluids), and activities that may lead to the contamination of clothing with micro-
organisms (i.e. bed making, bathing patient, cleaning).
• Plastic aprons should be used as single use items for one procedure or episode of patient
care and then discarded and disposed of as clinical waste.
• Aprons should be removed immediately after an episode of care and hands
decontaminated.
Full-body fluid- repellent gowns must be worn where there is a risk of extensive splashing of
blood, body fluids secretions or excretions (with the exception of perspiration) onto the skin or
clothing (e.g. Theatre scrub staff; when assisting with childbirth).
10.0
FACIAL PROTECTION (Eye protection and Masks)
Mucous surfaces of eyes and mouth must be protected when there is a risk of blood splash. Eye
protection may be achieved through the use of goggles, visors or spectacles with sidepieces. Eye
protection must be available in all areas and especially where splash is more likely e.g. A&E,
Endoscopy, theatres, Delivery Suite.
Eye protection should be worn when:
• Splashing or spray of blood/body fluid is likely
• Dealing with chemicals
• During aerosol and sputum producing procedures
• Eye protection must be comfortable to wear, fit correctly and allow for clear vision.
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• Eye protection that is designed for multi-use must be appropriately cleaned with detergent
and water and wiped with an alcohol-impregnated cloth between each use
Masks
• Masks are worn when there is a risk of respiratory transmission of micro-organisms or to
protect the healthcare workers from exposure to blood and body fluids.
• Masks must be worn correctly and be close fitting. They must be handled as little as
possible.
• Masks must be changed between patients or operations, and if they become wet or soiled
• Masks must be discarded immediately after removal and hands washed.
Guidance for selection of masks
There are a variety of masks available and staff must ensure that selection of the appropriate one is
based on the level of protection required. See Table below:
Type of mask
Protection provided
Indication for use
Standard surgical mask
No fluid repellence
Circulating theatre staff
Basic protection
Surgical mask with fluid shield
Direct fluid repellence
Surgical scrub team
No eye protection
During any procedures where
fluid exposure is anticipated.
Surgical mask with fluid shield and
Fluid repellence
Surgical scrub team
integral visor
Eye protection
During ant procedures where
fluid exposure is anticipated.
Major trauma
High level protection PFR mask
Filters 0.2- .5 microns
Multi-drug resistant TB
conforming to EN149 (“Duck Bill”)
Lasts up to 8 hours
Or the FFP2/FFP3 valve respirator
Suitable in high risk situations
SARS, Avian Flu, viral
mask
Training is required before use.
haemorrhagic fevers (FFP2 or
3)
11.0
ASSOCIATED POLICIES
The following Trust policies should be read in conjunction with this policy:
IC-Y3 Safe Handling and disposal of Sharps
IC-Y2 Safe handling of Clinical Waste policy
IC-Y5 Safe management of Linen
IC-Y4 Safe management of blood and body fluid spillages
IC-O9 Laboratory specimens
IC-P1 Decontamination of medical devices
Occupational health policy OC11 – Glove Usage Policy
12.0
MONITORING, CONTROL AND AUDIT
The monitoring of this policy within the Trust will be achieved by means of:
Active monitoring involving Infection control observational audits to ensure that clinical
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standards are met and maintained.
Trust wide audit of specific clinical practices e.g. hand hygiene compliance, PPE
Participation with the Trust PEAT focus group to monitor standards of cleanliness across
the trust.
Liaison with the clinical risk department to monitor number of reported incidents relating
to non compliance with this policy.
13.0
REFERENCES
The following documents were used as sources of reference for this policy:
Ayliffe G., Fraise A., Geddes A, Mitchell K., (2000)
Control of Hospital Infection – A practical Handbook, 4th ed. Arnold Publishing ISBN 0-340-75911-9
Control of Substances Hazardous to Health Regulation (COSHH) (1999). Health and Safety
Executive books ISBN 0-7176-1670-3
Health and Safety at Work Act (1974). HMSO
Infection Control Nurses Association (2002).
Hand decontamination Guidelines. London ICNA
and Regent Medical.
Infection Control Nurses Association (2002).
Protective Clothing – Principles and Guidance.
Infection Control Nurses Association (2002).
A Comprehensive Glove Choice.
Pratt R.J., Pellowe C., Loveday H.P., et al. (2007). Epic 2.
National Evidence-Based Guidelines for Preventing Healthcare Associated Infections in NHS Hospitals in England. Journal of
Hospital Infection, Vol.65, Supplement 1 p.1-64.
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Appendix 1
Recommended Hand Washing Technique
Wash hands using the following 8 steps.
Each step consists of five stokes rubbing backwards and forwards
1.
2.
Wet hands
Work into
under
hands, palm
running
to palm
water. Take
a measure
of soap.
3.
4.
Right hand
Rub palm to
over back of
palm, fingers
left and vice
interlaced.
versa.
5.
6.
Back of left
Rotational
fingers to
rubbing of
right palms,
right thumb
fingers
clasped in
interlocked
left hand and
and vice
vice versa.
versa.
7.
8.
Rub left
Left wrist
palm with
with right
clasped
hand and
fingers of
vice versa
right hand
and vice
versa.
Rinse hands under running water and dry thoroughly.
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Appendix 2
Guidance for glove use in healthcare settings
Type of Glove
Examples of Use
Comments
RUBBER
Domestic Services – for general Gloves should be washed with general-
(e.g. household gloves)
cleaning and decontamination
purpose detergent and water and dried
of the environment
thoroughly after each use.
Durable and can be reused
Handling rubbish
Colour coding should be evident when
cleaning a variety of areas, i.e. kitchens,
toilets etc.
If gloves become punctured or heavily
contaminated they must be discarded.
SPECIAL
For Estates work
Refer to Health and Safety policies.
(e.g. rubber gloves for electrical work)
Specific cleaning tasks
Can be reused
Heavy duty
Removing clinical waste etc
Clean according to manufacturers
Chain mail
Handling chemicals, solvents
instructions.
Heat resistant gloves
POLYTHENE SEAMED GLOVES
Catering purpose only
Offer limited protection
(Single use only)
Not recommended for protection against
blood borne viruses as seams are heat-
sealed and may split.
LATEX/VINYL GLOVES
Non sterile examinations
Latex/vinyl gloves must conform to
(Single use only)
Clinical examinations
TSS/D/300.010/012.
Phlebotomy
Latex gloves are recommended for and
Suitable for handling blood and procedures involving blood.
body fluids
Refer to Latex policy
Handling clinical waste bags
Vinyl gloves can be used for clinical
(from the neck)
purposes that do not involve prolonged
direct contact with blood.
Vinyl can be used as an alternative to
latex for short periods of use.
LATEX PROCEDURE GLOVES
Basic aseptic procedures e.g.
Should conform to TSS/0/33.011/1
(Single use only)
sterile dressing, catheterisation.
SURGEONS GLOVES
For contact with normally
Should conform to BS4004
(Single use only)
sterile parts of the body e.g.
during surgical and invasive
procedures.
BLUE NITRILE GLOVES
Alternative to latex gloves when
Should conform to MHRA requirements
sensitive to latex.
for class 1 medical devices.
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