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HPA South West Community Infection Control Guidelines 
2nd Edition (2007) 
 
 
 
 
 
 
 
 
 
PART B 
 
STANDARD INFECTION CONTROL 
PRECAUTIONS 
 
 
 
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HPA South West Community Infection Control Guidelines 
2nd Edition (2007) 
Introduction to the chain of infection16,17,18,19,20 
The way by which infection is spread can be thought of as a continuous chain 
with 6 links (see Table 1).  In order to prevent infection or stop it spreading, 
one or more links in the chain must be broken.  This can be achieved through 
practising standard infection control precautions. 
Link 1  Sources of micro-organisms.   
The main types of organism causing human infection include bacteria (e.g. 
salmonella), viruses (e.g. hepatitis A, B or C), fungi, or yeasts (e.g. candida).  
Infected people may act as a source of infection for others because the micro-
organisms may be found in certain body fluids and could be passed on to 
others.   
Link 2  Reservoirs for micro-organisms.   
These are places where the organism may live and survive.  Reservoirs can 
include people, animals, the environment, food or water. Contaminated food 
may act as a reservoir, for example if it is contaminated with salmonella or 
campylobacter. If the meat is not thoroughly cooked, those eating it may 
become infected.  Other examples of reservoirs for micro-organisms include 
articles such as towels, flannels, wash bowls, bed pans, contaminated 
equipment etc. 
Link 3  The way microbes leave the body  
Sometimes termed “portal of exit”, this can occur in a number of ways.  For 
example, salmonella leaves the body in the faeces and, if diarrhoea is 
present, high numbers of salmonella microbes are excreted. Tuberculosis 
uses the same entry and exit point in that it is inhaled and exhaled. 
Link 4 The method of spreading microbes from person-to-person 
Infections are spread in several ways, depending upon the infection. These 
include direct or indirect contact (including ingestion, sexual contact, mother 
to foetus, injection or inoculation) and some infections are airborne and are 
inhaled, e.g. pulmonary tuberculosis.  
Unwashed  hands are the most common way to spread infection. 
Microbes may be present in any body fluids (excreta and secretions). If hands 
come into contact with body fluids they may be carried from one person to 
another unless the hands are washed.  In addition the microbes can be 
spread from person-to-person via a contaminated environment (e.g. dust) or 
equipment. 
Some infections may be spread via the air, such as the cold and flu viruses. 
The infection may be spread in droplets or airborne spray produced by 
coughs and sneezes. Some childhood illnesses may also be spread in this 
way. 
Link 5 A susceptible person (person at risk of infection)  
People are at risk of developing infection if they are in contact with the 
organism in sufficient numbers to cause illness.  Immunity to some infections 
can be developed after being infected (e.g. chickenpox) or after immunisation 
(e.g. hepatitis B). 
 
 
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HPA South West Community Infection Control Guidelines 
2nd Edition (2007) 
Certain people are more susceptible or at greater risk of infection for a variety 
of factors. People who are very young or the very old are more at risk 
because their immune system may not be developed or may be waning.  In 
addition, some medications, such as steroids and cytotoxic agents can 
increase infection risk.  So can underlying diseases such as diabetes, blood 
disorders or cancer. 
Link 6 Microbes enter into the body  
Sometimes termed “portal of entry”. In order for microbes to cause infection 
they must gain entry into the body.  Different organisms have different ways 
of entering our bodies.  For example, salmonella need to be ingested (eaten). 
Some organisms may cause infection if they are inhaled e.g. tuberculosis. 
Others, such as hepatitis B, enter the bloodstream via broken skin, injection 
or sexual intercourse. 
Breaking the chain of infection 
Breaking the chain of infection by targeting one or more links can halt the 
spread of infection.  This usually involves: 
a) 
Eradicating the source of infection through appropriate antimicrobial 
therapy  
b) 
Preventing the method of spread through hand washing, hygiene, 
disposal of waste, decontamination of equipment etc or  
c) 
Protecting the individual at risk by immunisation 
d) 
Preventing microbes from entering the body by wearing protective 
clothing, using an aseptic technique when handling invasive devices, 
covering wounds and insertion sites with sterile dressings etc. 
It is impossible to identify everyone who is infectious to others.  Some 
diseases are infectious before any signs develop, such as chickenpox.  Some 
infections may not show any signs or symptoms, such as hepatitis B or HIV.  
Also some people may be carriers without developing the infection 
themselves, e.g. salmonella or MRSA. 
For this reason it is important that everyone carries out infection control 
precautions at all times, regardless of whether infection is present or 
suspected.  In the home it may not always be possible to practice standard 
infection control precautions to the same standard as in a clinical setting.  In 
addition in the home the risks of infection and its spread may be less than that 
in a clinical environment. 
Standard infection control precautions include: 
• Hand 
hygiene 
•  Use of protective clothing and equipment 
•  Cleaning and disinfection of equipment and the environment 
• Disposal 
of 
waste 
• Food 
hygiene 
• Laundry 
•  Management of inoculation injuries (bites/ and injuries with sharps and 
body fluids)  
•  Management of invasive devices and wounds (Part D Clinical 
Procedures
 
 
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HPA South West Community Infection Control Guidelines 
2nd Edition (2007) 
Table 1 Chain of Infection 
 
Source 
 
 
 
 
 
 
Reservoir 
 
Person at risk 
 
 
 
Chain of 
infection 

 
 
 
Way into 
Way out of 
 
the body 
the body 
 
 
Method of 
 
transmission 
 
 
 
 
Break one link of the chain to prevent infection 
 
 
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HPA South West Community Infection Control Guidelines 
2nd Edition (2007) 
B 1.0 Hand 
hygiene13,15,16,17,18,19,20,21,22,23,24,25,153 
Hand hygiene is widely recognised as the most important method of 
preventing infection and cross infection. In order to support the important role 
hand hygiene plays in maintaining patient safety, Swindon PCT have 
implemented the National Patient Safety Agency (NPSA) cleanyourhands 
campaign 
The purpose of hand hygiene is to remove or destroy any bacteria picked up 
on the hands (transient bacteria).  In some situations (e.g. prior to invasive 
procedures) it is necessary to also reduce the numbers of bacteria that 
normally live on the skin (resident bacteria). This prevents their being 
transferred to other people, while at the same time protecting oneself. A good 
hand washing technique is as important as the kind of product used.  
B 1.1  Hand hygiene facilities15 
B 1.1.1 Clinical settings 
Hand washing must be carried out using running water at a comfortable 
temperature.  Clinical hand washbasins should be provided wherever clinical 
care is being given, e.g. service users’ rooms in care homes, wards, 
treatment rooms, dirty utility rooms and kitchens.  A clinical hand washbasin 
consists of lever-operated mixer taps, with no plug and no overflow.  If mixer 
taps are not available for any reason a thermal control can be added to the 
hot tap to provide warm running water.  In care homes, staff should also be 
able to wash their hands under warm running water. 
Liquid soap should be used for hand washing.  This should be provided in 
wall-mounted dispensers with disposable cartridges or disposable pump-
action bottles.  Re-fillable cartridges are not recommended.  Dispensers must 
be kept clean and replenished.  
Aqueous antiseptic solutions or alcohol hand rubs/gels may also be used.  
Alcohol hand rubs/gels may be used as an alternative to soap and water, if 
the hands are visibly clean.  They are particularly useful in situations where 
hand washing may not be convenient. 
Hand creams may be used to help protect hands from soreness.  This must 
be supplied as individual tubes or in a pump-action container.  Communal 
pots must not be used. 
Disposable paper towels must also be available at all hand wash basins in 
clinical settings, including toilets and kitchens.  Communal (e.g. cotton) towels 
are not recommended in clinical settings.  Foot-operated waste bins must be 
used for disposal of paper towels.  Don’t use hands to raise the lid. 
B 1.1.2 Clients’ homes 
In clients’ own homes the hand hygiene facilities may not be ideal.  Staff 
visiting clients at home should carry a supply of alcohol free skin cleansing 
wipes and alcohol hand rub/gel.  These products may be used instead of 
hand washing if facilities are inadequate.  Alcohol hand rub/gel should be 
used on visibly clean hands and when hand disinfection is needed. Certain 
hand hygiene practices can increase the risk of skin irritation and should be 
avoided. For example, washing hands regularly with soap and water 
immediately before or after using an alcohol-based product is not only 
unnecessary, but may lead to dermatitis 
 
 
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HPA South West Community Infection Control Guidelines 
2nd Edition (2007) 
Staff should use pump-action liquid soap dispenser rather than bar soap.  Dry 
hands using paper towels or, if these are not available, use paper roll or a 
clean cotton towel.   
B 1.2  Routine hand hygiene 
The aim of routine hand hygiene is to remove dirt and most removeable 
(transient) micro-organisms found on the hands.  It is carried out in at least 
the following circumstances: 
• 
Before starting work and going home 
• 
After contact with body fluids e.g. dealing with incontinent clients 
• 
After removing personal protective equipment (PPE) 
• 
Before and after giving care  
• 
After using the toilet 
• 
Before eating and handling preparing food 
• 
After handling pets 
• 
After handling raw food 
• 
After handling refuse and clinical waste 
• 
When hands look or feel dirty 
• 
After any cleaning activities 
Before starting work, wash any broken or cut areas of exposed skin and cover 
with a waterproof dressing.  
For routine hand hygiene the technique is as important as the solution used.   
• 
Remove hand and wrist jewellery and wristwatches, and roll up 
sleeves.  Wedding rings without stones may be left in place 
• 
Wet hands under warm running water  
• 
Apply liquid soap 
• 
Rub this into all parts of the hands vigorously, without applying more 
water, using the 6-step technique (see Table 2) for at least 10-15 
seconds 
• 
Rinse hands under running water 
• 
Dry thoroughly using paper towels 
Alternatively: 
If hands are clean, apply sufficient alcohol hand rub/gel, to rub into all parts of 
the hands using the 6-step technique, until the alcohol has evaporated.  
Washing hands with soap and water is required after contact with patients 
with diarrhoea, because alcohol is less effective on micro-organisms such as 
Clostridium difficile and viral causes of gastroenteritis. 
 
 
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HPA South West Community Infection Control Guidelines 
2nd Edition (2007) 
B 1.3  Hand disinfection 
The aim of hand disinfection is the destruction of transient micro-organisms 
and a reduction in resident organisms.  It is carried out in at least the 
following circumstances: 
• 
Before invasive or aseptic procedures 
• 
After contact with people with known or suspected infection 
Any fresh abrasion, cut etc. on the hands should be covered with a 
waterproof dressing or appropriate barrier e.g. gloves. 
There are two ways of performing hand disinfection: 
• 
Wash hands as above using liquid soap, then apply sufficient alcohol 
hand rub/gel and rub into all surfaces of the hands until dry.  Alcohol 
hand rub/gel can also be used between cases if the hands are socially 
clean. Or 
• 
Wash hands as above using an aqueous antiseptic solution (e.g. 4% 
chlorhexidine-detergent or 0.75% povidone/iodine detergent). Lather 
all aspects of the hands and wrists using the 6-step technique for 2 
minutes.   
 
Table 2 Hand hygiene technique21,22  
 
 
 
 
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HPA South West Community Infection Control Guidelines 
2nd Edition (2007) 
B 2.0  Client’s Personal Hygiene 4,5,145 
B 2.1  Washing and bathing 
• 
Clients should have their own toothbrushes, razors, face cloths, soap, 
lotions, creams etc.  Communal items can spread infection. 
• 
Separate cloths must be used for cleaning of the client’s face/body 
and their genital/anal areas.  Disposable cloths could be used instead. 
• 
Antiseptics or salt should not be added to the bath water as they have 
little or no beneficial properties. 
• 
Daily bathing, shower, or a full body wash is best to prevent an 
accumulation of dirt and bacteria on the skin. This is particularly 
important for those who are incontinent. 
• 
Baths should be cleaned regularly with warm water and detergent or 
cream cleanser.  It is not usually necessary to add disinfectants. 
• 
In community hospitals or residential care settings wash bowls should 
be individualised if possible.  Alternatively the bowls must be cleaned 
and dried thoroughly between uses. 
B 2.2  Mouth care25,26 
• 
The most effective method of keeping the mouth clean, moist and free 
from infection is to brush the teeth/gums with a soft toothbrush and 
toothpaste after meals.  Disposable foam sticks may be used if the 
individual cannot use a toothbrush.   
• 
Frequent sips of water can also keep the mouth fresh and clean, if 
drinking is inadequate 
• 
Liquid paraffin e.g. Vaseline, may be used to moisten the lips 
• 
If the client produces too little saliva, 2-3 spays of artificial saliva can 
be sprayed inside the mouth up to 4 times daily 
• 
Antiseptic mouthwashes have a limited effect on mouth organisms and 
should not be used routinely 
• 
Dentures should be cleaned using a proprietary denture cleaner 
• 
Denture pots must be individualised 
• 
Removable braces must be cleaned daily 
 
• 
Keep toothbrushes clean and dry, replace periodically. 
• 
Regular dental checks can help to identify and prevent mouth 
conditions. 
 
 
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HPA South West Community Infection Control Guidelines 
2nd Edition (2007) 
B 2.3  Eye care25 
Special precautions are only needed if the eyes are damaged or after eye 
surgery.  In these cases, if eyes require cleaning, this should be performed 
using a low-linting swab, moistened with either normal saline or cooled boiled 
water. 
Hands should be washed prior to giving eye care.  The eyes should be wiped 
from the nose outwards, using a new piece of cotton wool or lint for each 
‘wipe’.  
Eye drops/ointment should only be used if they have been prescribed and 
have not past the expiry date.  Ensure there is good lighting.  Hands must be 
washed prior to instilling medications.  The patient should have their head 
well supported and tilted back.  Most eye medications are instilled just inside 
the lower eyelid. The outlet of the tube or bottle must not be allowed to touch 
the skin or eye. 
B 2.3.1  
Care of artificial eyes 
If the client's own eye has recently been removed, Chloromycetin ointment 
may be prescribed, and should be administered according to the instructions. 
Once the socket has settled, the false eye and socket should be cared for as 
follows: 
• 
The eyelids should be kept clean by bathing or wiping with cotton wool 
or soft lint moistened with normal saline or cooled boiled water. 
• 
If the false eye has become dirty, it should be cleaned in normal saline 
or cooled boiled water.   
• On 
no account should the eye be washed in any type of detergent, as 
this may cause irritation to the socket and surrounding skin. 
B 2.4  Ear care 
Ears should be kept clean and dry and examined periodically for signs of 
infection.  Items such as cotton buds should not be used to remove wax from 
the ears.  The removal of wax can be promoted by chewing.  If a build up of 
wax in the ear is noted it may be worth instilling a few drops of wax remover, 
following the manufacturer’s directions.  
Only health care professionals who have received training in the irrigation 
(syringing) of ears, and are deemed to be competent, may undertake this 
procedure.  Usually individuals who need to have their ears syringed are 
referred to their local general practice.  Mechanical ear syringing machines 
are now recommended and metal syringes should not be used. 
Further advice on ear care can be obtained by visiting the website of the 
Primary Ear Care Centre: www.earcarecentre.com.  See the website or Table 
6
 for details on how to decontaminate ear syringing machines. 
B 2.4.1  
Cleaning “behind the ear” hearing aids 
• 
Separate the hearing aid from the ear mould by pulling the flexible 
tubing away from the hooked part of the hearing aid.  Take care not to 
pull the tubing out of the ear mould.  If the tube is stiff, do not force it. 
 
 
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HPA South West Community Infection Control Guidelines 
2nd Edition (2007) 
• 
Wash the ear mould and flexible tube in warm soapy water (not 
detergent or cleaning liquid).  A brush can be used to remove any wax 
from the tube. 
• 
Rinse the ear mould in clean water.  Dry the tubing and ear mould by 
tapping gently onto a tissue held in the hand to remove drops of water.  
Ensure no droplets remain. 
• 
Leave the ear mould and attached tubing to dry in a warm (not hot) 
place 
• 
Once the ear mould and tubing are dry, reattach to the aid  
• 
Contact the local audiology department for further information. 
B 2.5  Foot care27,28 
Good foot care is essential to ensuring the health of the feet and preventing 
wounds and disease of the feet.  In care homes residents tend to be at 
special risk especially during times of immobility, during which pressure-
relieving devices must be used.  Certain individuals are at increased risk of 
foot disease, including people with diabetes, neuropathy and ischaemic 
disease. 
Good fitting shoes can help promote healthy feet for all clients. Footwear 
needs to: 
• 
Be worn – not kept for best and going out 
• 
Be made of soft non-occlusive material with no seams or knots 
• 
Have light-weight and shock-absorbing soles with a cushioned insole 
• 
Be of the correct length, width and depth 
• 
Have a broad fronts with plenty of toe room and a soft padded heel 
cuff 
• 
Hold the foot steady by means of good laces, buckles or Velcro 
fastening 
• 
Be fitted by a trained fitter with the client standing 
The following measures will also help to promote healthy feet and prevent 
injury. 
• 
Examine the feet regularly (preferably daily especially in high risk 
groups) 
• 
Ensure the shoes fit correctly 
• 
Those at risk of foot disease should avoid walking in bare feet 
• 
Wash feet daily using warm water and mild soap 
• 
Dry thoroughly, but not roughly, especially between the toes 
• 
Change socks and hosiery daily 
• 
If the skin is dry, apply hand cream or moisturising cream to the heels 
and balls of the feet 
 
 
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HPA South West Community Infection Control Guidelines 
2nd Edition (2007) 
• 
Cover any cuts with a sterile dressing and report to a State Registered 
Chiropodist if in a high risk group 
• 
Trim nails regularly, following the natural shape of the toe. Do not cut 
down the sides 
• 
Carers should not trim the nails of people in high risk groups, unless 
they are deemed competent by a State Registered Chiropodist 
• 
Clients should be able to see an NHS chiropodist free of charge, 
providing they have a medical or podiatry need.  Check with the local 
NHS Podiatry Service for access criteria and available services. 
• 
To prevent the spread of infection, individual clients should have their 
own nail clippers and nail files.  
• 
People with diabetes should have a risk assessment carried out at 
least annually by a registered health professional 
• 
Don’t cut corns, calluses or in-growing toenails 
B 2.5.1  
Diabetic foot ulcers27,28 
Diabetic foot ulcers need to be assessed at least once a year and treated 
appropriately, so refer to a specialist clinic.  Good fitting shoes can help avoid 
foot ulcers, see the notes above.  
The hospital-based chiropodists/podiatrists and orthotists may have a range 
of information leaflets and may offer training. 
Inadequate assessment, and failure to implement preventative measures, 
may result in unnecessary amputation. 
Improve general health and circulation by: 
• Controlling 
diabetes 
• Reducing 
cholesterol 
• 
Treating high blood pressure 
• Stop 
smoking 
• 
Observe for changes in the feet (cuts, bruises, blisters, redness, 
corns, calluses, verrucas) and seek professional advice 
 
 
 
 
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HPA South West Community Infection Control Guidelines 
2nd Edition (2007) 
B 3.0 Protective 
clothing/equipment13,29,30,153 
Protective clothing is an essential part of health and social care.  It provides 
protection from micro-organisms for both carers and clients.  It is used to 
protect the skin (and sometimes airway or mucous membranes) from contact 
with blood and body fluids, and also protects clothing from contamination.  
The use of protective clothing should be based on an assessment of the risk 
of spread of micro-organisms from person to person and the risk of 
contamination of the carer’s clothing or skin. 
B 3.1  Disposable gloves30 
A range of appropriate gloves should be available and accessible to staff 
(Table 3) 
• 
Gloves are to be worn whenever contact with body fluids, mucous 
membranes or non-intact skin is anticipated 
• 
Gloves are not to be worn as an alternative to hand hygiene 
• 
Gloves should be changed after each procedure and hands washed 
following their removal 
• 
To remove glove: grasp wristband and pull forwards over the hand and 
fingers, inverting the glove.  Avoid contaminating the skin 
• 
Washing gloves with soap and water or alcohol should not be 
undertaken, because this may not be effective and may damage the 
glove 
• 
Gloves should be seamless, well fitting and powder-free. 
• 
A latex-free glove should be available for anyone who has a latex 
allergy 
 
 
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HPA South West Community Infection Control Guidelines 
2nd Edition (2007) 
Table 3 
Selection of appropriate gloves30 
Procedure to be performed 
Suitable Gloves 
1.  Invasive procedures which involve  Sterile, non-powdered latex examination, 
breaking the skin, e.g. surgery, for 
or surgeons’ glove. 
which high levels of protection for the 
 
client and carer are required 
For those who are sensitised to natural 
rubber latex (clients and staff), there are 
synthetic materials available e.g. nitrile or 
neoprene 
2.  Non-invasive procedures 
Non-sterile, non-powdered vinyl or latex 
involving exposure to blood or body 
examination glove. 
fluids, or exposure to excreta, such as   
urine, faeces, vomit, and where there 
For those who are sensitised to natural 
is little likelihood of exposure to blood 
rubber latex, there are synthetic materials 
or hazardous/corrosive substances. 
available e.g. nitrile or neoprene. 
 
Polythene gloves are not recommended. 
3.  General cleaning procedures 
Flock-lined, latex, nitrile or vinyl gloves. 
 
If contact with blood or body fluid is likely, 
wear a glove that is comparable with (2) 
outlined above 
4.  Handling chemicals, or other 
A glove that offers the necessary 
hazardous substances 
protective qualities, e.g. latex for high 
resistance to water-based chemicals and 
nitrile for resistance to solvents and oil-
based chemicals. 
5.  Food handling 
Polythene, if necessary 
 
B 3.2  Aprons/gowns 
These are worn to protect the clothing from contamination.  The decision to 
wear an apron is based upon an assessment of the risk of contamination with 
body fluids e.g. diarrhoea. They are single use and should be changed 
between tasks, then discarded appropriately. Colour coding of the aprons can 
be useful, though not essential.  An example of this may be: 
Blue  
food handling and feeding 
White  
general uses 
Red 
in wards and communal settings, when caring for clients with 
infection 
Examples of when they should be worn: 
• During 
bathing 
• 
When helping clients in the toilet 
• 
When cleaning equipment, sanitary equipment and environment 
• 
During bed making 
• 
During food handling 
 
 
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HPA South West Community Infection Control Guidelines 
2nd Edition (2007) 
Full-length, long-sleeved, fluid-repellent gowns should be worn when there is 
a risk of gross contamination with body fluids, e.g. assisting during childbirth 
or caring for a patient in isolation with highly contagious diseases such as 
Severe Acute Respiratory Syndrome (SARS). 
B3.3  Masks, visors, eye protection 
These are worn when a particular procedure is likely to cause splashing of 
blood, tissues or chemical into the eyes, face or mouth.  
A high-efficiency, particulate filter mask (known as a respirator) should be 
worn when caring for a client who is known to have sputum smear positive 
(open) tuberculosis of the lung or SARS.  These can be obtained via supplies, 
directly from the manufacturer or, in an emergency, from the chest unit at the 
local district general hospital.  Advice on whether it is necessary to wear a 
mask can be obtained from the Health Protection Unit or the local clinical 
team responsible for the care of the client.   
B 3.4  Uniforms 
• 
Uniforms do not constitute protective clothing 
• 
During the course of the working day uniforms will become 
contaminated with micro-organisms 
• 
Uniforms should be protected from gross contamination by the use of 
disposable aprons. 
• 
Uniforms should have short sleeves and should not be fitted with 
buttons.   
• 
The material should be able to withstand a wash temperature of 60oC.   
• 
Staff should change into normal clothing at the end of the working day. 
• 
If wearing uniform to and from work is unavoidable, cover uniform with 
an outer layer 
• 
A sufficient supply of uniforms should be provided so that a clean 
uniform can be worn every day 
• 
If staff wear their own clothes in the workplace similar hygiene 
measures should be employed. 
 
 
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HPA South West Community Infection Control Guidelines 
2nd Edition (2007) 
B 4.0  Cleaning/decontamination of the environment29,31, 129, 131, 153 
B 4.1  Introduction  
In general, it is considered that the environment has a relatively low role in the 
transmission of infection.  However the environment is known to play an 
important role in cross infection during outbreaks.  Door handles, flush 
handles, taps etc have all been implicated.  Therefore, special attention must 
be played to these fittings during outbreaks. 
In addition, accumulations of dust, dirt and liquid residues will increase 
infection risks and must be reduced to the minimum. This can be achieved by 
regular cleaning and by using good design features in buildings, fittings and 
fixtures.  Contact the Health Protection Unit / Infection Control Team for 
advice. 
An audit programme for monitoring the standard of hygiene should be in 
place in all community hospitals and residential care settings. 
B 4.2  Clinical settings  
A written cleaning schedule should be devised, based on a Control of 
Substances Hazardous to Health29 (COSHH) assessment, which includes the 
management of spillage of body fluids and regular removal of dust by damp 
dusting high and low horizontal surfaces.  This should specify the persons 
responsible for cleaning (especially in the cleaner's absence), the frequency 
of cleaning and methods used and the expected outcomes.   
Work surfaces and hard floors should be smooth-finished, intact, durable, of 
good quality, washable, should not allow the pooling of liquids and be 
impervious to fluids.   
Carpets are not recommended in treatment rooms or other clinical areas likely 
to be regularly contaminated with body fluids.  Where carpets are provided 
there should be procedures or contracts in place for regular cleaning and for 
dealing with spillage.  Curtains should be cleaned when soiled or periodically 
(e.g. six monthly) and an adequate supply of curtains purchased to facilitate 
this. 
B 4.3  Client’s own homes 
The main aim of hygiene in the home is to target those places where 
pathogenic microbes may reside and have the potential to cause infection, 
e.g. toilets, kitchens and spillages of body fluids.  Normal cleaning methods, 
such as vacuuming and damp dusting/cleaning surfaces, are generally all that 
is required.  If another member of the family, or an informal carer, lives there 
be sure they know what you are doing and why.  Tact may be needed as they 
may feel the house is clean enough already, especially if they do the cleaning 
normally. 
 
 
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HPA South West Community Infection Control Guidelines 
2nd Edition (2007) 
B 4.4  Cleaning materials 
Disposable, non-shedding cloths or paper roll should be provided for cleaning 
purposes.  Equipment and materials used for general cleaning should be kept 
separate from those used for the cleaning of body fluid spillage. Do not leave 
cloths or mops stored in disinfectants or buckets.  Colour coding of cleaning 
equipment (cloths, mops, gloves) is advisable, for example: 
Green  
Kitchens only, never used elsewhere.  
Blue   
General areas e.g. offices, wards/departments 
Yellow  
Washbasins, washroom surfaces. 
Red 
 
High risk areas e.g. sluices, toilets, washroom floor 
White   
Isolation rooms, operating theatres and anterooms 
Cream cleaner or a hard surface cleaner is usually suitable for cleaning hand 
washbasins and general-purpose detergent is recommended for other 
environmental cleaning.  Follow manufacturer’s instructions. Wipes 
impregnated with 70% alcohol can be used for those items that cannot be 
immersed e.g. electrical equipment.  A COSHH assessment is required for 
any cleaning materials used. 
For suggested methods and frequencies of cleaning the environment and 
equipment, refer to Table 6. 
B 4.5  Management of the spillage of blood and high-risk body fluids11 
Spillages of blood and high-risk body fluids must be dealt with quickly and 
effectively.  Disposable gloves and an apron must be worn and in clinical 
settings the contaminated debris treated as clinical waste. In domiciliary 
settings the waste should be contained in a plastic bag that is securely tied 
and discarded in the household waste. 
Chlorine-releasing agents can be a hazard especially if used in large 
volumes, in confined spaces or mixed with other chemicals or urine.  
Protective clothing must be worn and the area well ventilated.  A risk 
assessment and COSHH assessment must be carried out if using these 
chemicals.  Increased risk is related to the likelihood of infection.  Following a 
risk assessment and depending upon the products available, spillage may be 
dealt with by any of the following methods. 

4.5.1 
 
Sodium dichloroisocyanurate (NaDCC) method (not 
carpets and soft furnishings) 

• 
Wearing protective clothing, cover spillage with NaDCC granules 
• 
Leave for at least two minutes 
• 
Scoop up the debris with paper towels and/or cardboard 
• 
Wash the area with detergent and water and dry thoroughly 
• 
Dispose of all materials as per B 7.0 
• 
Clean the bucket/bowl with fresh soapy water and dry 
• 
Discard protective clothing and wash hands 
 
 
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HPA South West Community Infection Control Guidelines 
2nd Edition (2007) 
B 4.5.2  
Hypochlorite method (not carpets and soft furnishings) 
• 
Wearing protective clothing, soak up excess fluid using disposable 
paper towels 
• 
Cover area with towels which have been soaked in 10,000 parts per 
million of available chlorine (e.g. Haz Tabs) and leave for at least two 
minutes 
• 
Remove organic matter using the towels and discard as per B 7.0 
• 
Clean area with detergent and water and dry thoroughly 
• 
Clean the bucket/bowl in fresh soapy water and dry 
• 
Discard protective clothing and wash hands  
 
B 4.5.3 
Detergent and water method (for soft furnishings and 
carpet) 

• Steam 
clean 
or 
• 
Wearing protective clothing mop up organic matter with paper towels 
or disposable cloths 
• 
Clean surface thoroughly using a solution of detergent and water and 
paper towels or disposable cloths 
• 
Rinse the surface and dry thoroughly 
• 
Dispose of materials as per B 7.0 
• 
Clean the bucket/bowl in fresh hot, soapy water and dry 
• 
Discard protective clothing 
• Wash 
hands 
B 4.6 
Management of spillage of low-risk body fluids (urine, 
faeces, vomit etc)  

• 
Wearing protective clothing mop up organic matter with paper towels 
or disposable cloths 
• 
Clean surface thoroughly using a solution of detergent and water and 
paper towels or disposable cloths 
• 
Rinse the surface and dry thoroughly 
• 
During outbreaks of viral gastroenteritis disinfect surfaces using 0.1% 
chlorine solution after cleaning 
• 
Dispose of materials as per B 7.0 
• 
Clean the bucket/bowl in fresh hot, soapy water and dry 
• 
Discard protective clothing 
• Wash 
hands 
 
 
 
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HPA South West Community Infection Control Guidelines 
2nd Edition (2007) 
B 4.7  Routine cleaning of isolation rooms 
• 
Wear personal protective clothing (at least disposable gloves and 
apron) 
• 
Use a fresh solution of detergent and water and disposal cloths or 
paper roll.  If indicated, e.g. outbreaks of gastrointestinal infection, 
disinfect with chlorine-releasing agent after cleaning or use a 
combined cleaner-disinfectant.  Change cleaning solution frequently 
• 
Clean or damp dust in the following order, if possible: 
• 
Fittings and furniture using detergent and water 
• 
High level surfaces and curtain rails 
• 
Door handles and horizontal surfaces 
• Patient 
equipment 
• 
Bath or shower room, toilet 
• 
Mop the floor 
• 
Discard waste as clinical waste 
• 
Empty waste bin, clean inside and out, and insert new liner 
• 
Clean all cleaning equipment and leave to dry 
• 
Restock paper towels, liquid soap and other supplies 
• Wash 
hands 
B 4.8  Terminal cleaning of isolation rooms 
• 
In addition to the above 
• 
Remove/dispose of unwanted items (flowers, equipment etc) 
• 
Clean, and disinfect if necessary, all furniture and fittings 
• 
Take down curtains and send to the laundry 
• 
Strip the bed.  Clean mattress with detergent solution and 
disinfect if necessary 
• 
Vacuum the floor 
• Hang 
clean 
curtains 
 
 
 
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HPA South West Community Infection Control Guidelines 
2nd Edition (2007) 
B 5.0 
Cleaning/decontamination of equipment29,32-52, 146, 153 
The decontamination of medical devices has been the subject of a number of 
Health Service Circulars (HSC1999/179 and HSC 2000/032).  All NHS 
premises must comply with the National Decontamination Strategy by 31 
March 2007, monitored by the Healthcare Commission.  Options include: 
• 
Centralise all decontamination to an accredited Sterile Services 
Department 
• 
Use only single-use devices 
• 
Undertake decontamination locally to all applicable standards 
• 
A combination of the above 
For information for PCTs visit: 
http://www.dh.gov.uk/assetRoot/04/12/17/93/04121793.doc  
The national decontamination training programme can be accessed at: 
http://decontaminationtraining.nhsestates.gov.uk/ 
B5.1 Risk 
assessment32 
Equipment can be categorised according the risk of infection it poses to the 
client.  
• 
Items in contact with intact skin are classed as low risk and should be 
cleaned. 
• 
Items in contact with mucous membranes (eyes, mouth or rectum) are 
classed as medium risk and at least disinfected between uses.   
• 
Items that enter the body or have contact with broken skin, broken 
mucous membranes or with the vagina37 are classed as high risk and 
must be single use or sterilised. 
 
 
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HPA South West Community Infection Control Guidelines 
2nd Edition (2007) 
Table 4 Risk assessment for decontamination of equipment32 
 

Risk 
Application of Item 
Recommendation 
 
Low 
•  In contact with healthy skin or:  Single use item or  

Clean item  
  Not in direct contact with 
 
patient  
e.g. furniture, mattresses, 
surfaces. 
Medium 
•  In contact with mucous 
Single use item or  
membranes or  
Clean item then disinfect or 

sterilise 
  Contaminated with virulent or 
 
readily transmissible 
(Item does not need to be 
organisms (body fluids); or: 
sterile when used) 
•  Prior to use on immuno-
 
compromised patients 
 
e.g. thermometers, auroscope 
NB Items used in the vagina or 
earpieces. 
cervix must be single use or 
sterilised37 
High 
•  In contact with a break in the 
Single use item or  
skin or mucous membrane; or: 
Clean item then sterilise  

 
  For introduction into sterile 
Use item sterile 
body areas 
e.g. uterine sounds, surgical 
instruments 
(Adapted from Medical Devices Agency,1999 - updated 2002 & 2005)32 
 
B 5.2  Cleaning29,32-36 
Thorough cleaning with detergent and/or enzymatic cleaner and warm water 
(body temperature) will remove large numbers of micro-organisms from a 
surface, especially if the article can be rinsed. A further reduction in numbers 
occurs as the surface dries.  Devices cannot be effectively disinfected or 
sterilised without having first been thoroughly cleaned and dried.  Cleaning 
will not be effective if surfaces are damaged or rusty. 
An automated method such as a thermal washer/disinfector is the most 
effective cleaning method and is recommended for cleaning all medical 
devices including surgical instruments.  
B 5.2.1  
Washer-disinfectors32,35 
Thermal washer-disinfectors physically clean devices and kill micro-
organisms by applying hot water at disinfection temperatures.  They are used 
for cleaning instruments, bedpans, urinals and other devices.  They must 
have a contract for planned preventive maintenance and must be cleaned 
and maintained in accordance with Health Technical Memorandum (HTM) 
203035.  Daily records must be kept of the cycle. 
 
 
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HPA South West Community Infection Control Guidelines 
2nd Edition (2007) 
B 5.2.2  
Ultrasonic washers32,35 
 
Ultrasonic washers are not recommended for use in NHS premises.  If used: 
• 
Ultrasonic cleaners must be used in accordance with manufacturer’s 
instructions and HTM 2030. 
• 
The lid must be on when operated to avoid the dispersal of aerosols 
and to protect users from noise. 
• 
These cleaners cannot be used for plastic or similar materials 
• 
Cannulated instruments can be used in ultrasonic washers, but must 
also be flushed or brushed with cleaning solution, or attached to a 
nozzle on the washer 
• 
Check with the manufacturer that the washer is suitable for the items 
to be cleaned 
• 
Hinged items should be opened before loading in the washer 
• 
Remove gross contamination and soiling from devices before loading 
• 
A low foaming surfactant or detergent should be used in the washer 
• 
Fill with clean water and the required volume of detergent prior to use 
• 
Bring up to the operating temperature and operate for at least 5 
minutes to de-gas the solution 
• 
After de-gassing load the washer and replace the lid 
• 
Once clean (after the recommended time) remove the basket and 
rinse instruments in very hot water (at least 600 C) before drying 
• 
Empty the tank after 4 hours, or when visibly soiled, or at the end of 
the session, whichever is soonest.  Clean and dry. 
B 5.2.3  
Manual cleaning32,36 
 
Medical devices and instruments must not be cleaned by hand although this 
is an acceptable method for cleaning the environment and low risk patient 
equipment such as beds, commodes etc. A risk assessment and records of 
agreed procedures must be in place to ensure that a consistent method is 
employed by all staff.  Disposable gloves and apron are advised, and the use 
of enzymatic cleaners or detergent and warm water (not exceeding 350 C).  
Avoid generating splash by immersing the item where possible.  If splash is 
unavoidable wear protective eyewear.  After cleaning, rinse and inspect the 
equipment.  If the item remains soiled, repeat the cleaning process.  Ensure 
the item is dried as quickly as possible either using paper roll or by inverting 
to air-dry. 
B 5.2.4  
Cleaning materials 
Cleaning equipment (brushes, mops etc.) must be kept clean and dry 
between uses. Re-usable cloths are not recommended.  
 
 
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HPA South West Community Infection Control Guidelines 
2nd Edition (2007) 
B 5.3   
Disinfection32 
Disinfection is a process used to reduce the number of micro-organisms to a 
level that is considered safe, but which may not necessarily destroy some 
viruses or bacterial spores.  Disinfection is usually acceptable for devices that 
pose a medium risk of infection if these devices cannot be effectively 
sterilised.  Disinfection can be achieved in a number of ways including the 
use of heat and chemical disinfectants.  Both methods have their drawbacks 
and it is often safer and more convenient to use a disposable device instead.  
Further advice can be obtained from the publication Guidance on 
Decontamination,
 prepared by the Microbiology Advisory Committee to the 
Medical Devices Agency.  It is available on a CD-ROM and on the Medicines 
and Healthcare Products Regulatory Agency’s website: www.medical-
devices.gov.uk. 
B 5.3.1  
Heat disinfection32 
Dishwashers, washing machines and washer-disinfectors are effective 
methods for disinfecting equipment because they clean the item and then 
expose the items to hot water for the required time to achieve thermal 
disinfection. 
650 C for 10 mins 
710 C for 3 mins 
800 C for 1 min 
900 C for 1 sec 
Washer-disinfectors must be maintained in accordance with manufacturer’s 
instructions and validated using HTM2030, with particular emphasis on 
ensuring that the cleaning process is effective. 
B 5.3.2   
Chemical disinfection32,39,40 
Chemical disinfectants can be toxic, flammable, corrosive or have other 
material incompatibilities, so their use should be avoided wherever possible.  
Even when laboratory tests have demonstrated the effectiveness of a 
particular chemical to kill specific micro-organisms, in practice it may fail to do 
so for a number of reasons.  These include: 
• 
Inactivation of the disinfectant by a wide variety of substances, such 
as organic matter (blood and body fluids), certain detergents, wood, 
cork, plastics, rubber, some inorganic chemicals 
• 
Presence of organic material preventing the disinfectant from 
contacting the surface of the object 
• 
Decay of a disinfectant and loss of efficiency due to time, temperature, 
impurities, incorrect dilution 
• 
Incorrect contact time 
Chemical disinfectants must be used at the correct dilution and the device 
immersed for the correct length of time, depending upon the manufacturer’s 
instructions.  Disinfectants must also be suitable for the types of micro-
organisms targeted.  A COSHH assessment must be undertaken when 
selecting a chemical disinfectant in order to safeguard health. 
 
 
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HPA South West Community Infection Control Guidelines 
2nd Edition (2007) 
B 5.3.2.1 
Using a chemical disinfectant:32,40 
• 
Ensure the disinfectant receptacle is clean and dry 
• 
Ensure the device is clean and dry 
• 
Wearing protective clothing fill the receptacle with sufficient freshly 
prepared disinfectant to allow complete immersion of the device 
• 
Immerse the device in the solution, ensuring there are no air bubbles 
and that the disinfectant has contact with all surfaces including the 
lumen of tubes 
• 
Cover the receptacle and leave for the correct length of time, using a 
watch 
• 
Rinse the device in water of suitable quality, e.g. sterile water 
• 
Dry using clean, non-shedding cloth or paper 
• 
Wash, dry and disinfect or sterilise the receptacle before storing dry 
B 5.3.2.2 
Selecting a chemical disinfectant32,39,40 
There should be very few reasons for using a disinfectant and, where 
possible, disposables or sterilisation are recommended. 
Disinfectants must be stored, reconstituted and used in accordance with 
COSHH regulations. 
Chlorine preparations39,40 
These include Sodium hypochlorite and Sodium dichloroisocyanurate 
(NaDCC).  They usually are presented in the form of tablets, powders or 
granules that are then reconstituted into the required concentration.  In liquid 
form they are less stable and have a shorter shelf-life. NaDCC releases 
chlorine slowly and has a more prolonged effect than Sodium hypochlorite.  
Chlorine preparations are corrosive to metals and inactivated by organic 
matter, though NaDCC is less so than sodium hypochlorite.  They should not 
be used on urine as this may release chlorine vapour, which is hazardous.   
Milton is often used for disinfecting infant feeding equipment and catering 
equipment. 
 
Examples: 
Haz Tabs, Actichlor, Precept, Sanichlor, Milton   
 
 
See dilution table overleaf…
 
 
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HPA South West Community Infection Control Guidelines 
2nd Edition (2007) 
 
 
 
Dilution of 
Available 
Parts per 
stock solution 
chlorine 
million 
 
Undiluted 10* 
100000* 
Blood spills 
1:10 1%  10,000 
Environment 
1:100 0.1%  1,000 
Clean 
1:200 0.05% 500 
instruments 
Catering/infant 
1:800 0.0125% 
125 
feeding 
* Approximate values of some brands: Chloros, Sterite, Domestos etc38 
Alcohol preparations 
Alcohol preparations are useful chemical disinfectants because they ready 
diluted and can be used immediately.  They are effective against most 
bacteria and viruses, but have poor penetration. They are flammable so must 
not be used near naked flames or sparks.  They evaporate rapidly and can be 
used on equipment that may be damaged by other methods of 
decontamination.  Disinfection occurs during evaporation of the alcohol, so 
items must be dry before use.  Examples include: 
Ethanol, Industrial methylated spirit  
70% 
Isopropyl alcohol 
   60-70% 
Alcohol impregnated swabs (Sterets)  70% 
Alcohol hand rubs/gels 
 
 
70% 
Chlorhexidine 
Chlorhexidine is a skin disinfectant that is very effective at reducing 
Staphylococcus aureus and other organisms found on the skin.  It is often 
used to decontaminate hands prior to invasive procedures such as minor 
surgery.  It is not suitable for cleaning equipment or the environment.  
Examples include: 
Hibiscrub 
Hibitane 
Combined detergent-disinfectants 
Products are available that combine a detergent and a chlorine-based 
disinfectant for use when cleaning the environment and in particular sanitary 
equipment (baths, showers, toilets etc), especially used during outbreaks of 
gastrointestinal infection.  Examples include: 
Titan Sanitiser, Chlorclean, Actichlor plus 
 
 
 
 
 
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HPA South West Community Infection Control Guidelines 
2nd Edition (2007) 
B 5.4  Sterilisation32 
Sterilisation is a process used to render an object free from all micro-
organisms. 
It is recommended that sterile equipment should be obtained pre-sterilised 
from a manufacturer or via a Central Sterile Supplies Department (CSSD).  
Bench top steam sterilisers need intensive maintenance and rigorous controls 
in place to ensure their effectiveness and their use should be restricted to 
situations where CSSD or disposables are not available.  The decision to use 
bench top steam sterilisers should be accompanied by a risk assessment.  
Systems and records must be in place to ensure that all staff employ 
consistent methods and equipment is functioning effectively.  NHS 
organisations must be able to demonstrate compliance with the National 
Decontamination Strategy by 31 March 2007 and the Healthcare Commission 
will monitor compliance. 
 
B 5.5  The use & maintenance of bench top steam sterilisers 32,41-49 
 
The use of bench top steam sterilisers should be restricted to those situations 
where it is not possible to utilise the services of the Central Sterile Supplies 
Department. Users and owners must be aware of the legal implications in the 
event of infection or untoward exposure that may result from procedures 
using devices that have been processed incorrectly. Operators of sterilisers 
must be suitably trained and the steriliser maintained and tested frequently to 
ensure that it is achieving sterilising conditions consistently. 
 
Where it is agreed that a bench top steam steriliser will be used, the model of 
steriliser used must be appropriate for the load.  A standard (downward 
displacement) bench top steam steriliser is intended specifically to process 
solid, unwrapped instruments without lumens.  Vacuum (porous load) bench 
top sterilisers may also be used to process wrapped loads and instruments 
with lumens.  The latter are expensive to buy and their cost of ownership is 
high, because testing and maintenance is complicated and takes a long time.  
 
The safe operation of steam sterilisers include: 
 
• 
Daily checks by the User and other periodic testing by a qualified test 
engineer  
• 
Provision of clean steam by correct management of the reservoir and 
chamber  
• 
Quarterly servicing and maintenance 
• Correct 
loading 
• 
Accurate record keeping and log book maintenance 
• 
Training of the operator 
 
These are outlined below, but detailed guidance on the purchase, use and 
operation of bench top steam sterilisers can be found in bulletins published by 
the Medical Devices Agency 42,43.  Health Technical Memorandum 201045 
provides comprehensive guidance on all aspects of sterilisation and 
sterilisation processes.  
 
 
 
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HPA South West Community Infection Control Guidelines 
2nd Edition (2007) 
B 5.5.1 Purchase of a bench top steam steriliser  
 
Those involved in the purchase of equipment should refer to MDA DB 2002 
(06) 42 and must obtain the supplier’s assurance that the steriliser is suitable 
for the loads that the user intends to process, because some machines have 
limited function.  For advice contact the Infection Control Team, an 
Authorised Person (sterilizers) (contact details available from PASA – 
www.pasa.nhs.uk) or Strategic Health Authority Decontamination Lead. 
 
The processing of wrapped instruments and utensils, instruments with lumens 
and the processing of porous loads cannot be carried out in standard bench 
top steam sterilisers.  Items such as these must be processed in a vacuum, or 
porous load, steriliser that the manufacturer has validated for this type of load. 
 
B 5.5.2 Installation and commissioning of a bench top steam steriliser42 
 
After a steriliser has been installed, it must be checked and tested 
(commissioned) by a properly trained and qualified test person who may be 
employed by the manufacturer or a contractor.  These checks and tests are 
intended to demonstrate that the steriliser functions correctly and complies 
with the specification.  The test results must be recorded in the steriliser 
logbook.  A steriliser that has not been commissioned, or fails any test during 
commissioning, or periodic testing, must not be used until the cause has been 
identified and corrected.  It must then be fully re-tested and fulfil all test 
requirements satisfactorily before being used. 
 
B 5.5.3 Logbook42
 
 
Each steriliser must have its own logbook, which provides a permanent 
record of all testing, maintenance and repairs performed on the steriliser.  It 
must contain a record of all actions taken in the event of a failed cycle or a 
failed test.  The logbook may provide useful evidence in a case of litigation. 
  
B 5.5.4 Testing and Maintenance42 
 
The owner/user is responsible for daily/weekly testing, which are designed to 
show that the operating cycle functions correctly. See Table 5.    Record  all 
observations in the logbook. An independent recording device can be fitted to 
some types of steriliser and will provide a permanent record that can be kept 
in the logbook.  The observed values must be within the established time-
temperature limits for the cycle.  A more comprehensive description is given 
in MDA DB 2002 (06).  
 
A Test Person (sterilisers) must conduct quarterly and annual testing.  
Owners of bench top steam sterilisers must ensure that the steriliser is 
subject to a planned and documented schedule of preventative maintenance.  
The manufacturers will also advise on these aspects.  HTM 2010 Part 3 
provides comprehensive information on all aspects of testing bench top steam 
sterilisers.  
 
 
 
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HPA South West Community Infection Control Guidelines 
2nd Edition (2007) 
B 5.5.5  
Indicators 32,42,49 
 
Chemical and biological indicators play only a limited part in the validation and 
routine control of steam sterilisers.  They are regarded as supplementary to 
the measurement of temperature, pressure and time. They may not 
demonstrate sterility of the load and may serve only to distinguish loads that 
have been sterilised from those that have not. 
 
If chemical or biological indicators are used, they must be correctly selected 
and used for the process specified by the manufacturer.  The same applies to 
the use of steam penetration test kits.  Results must be recorded in the log 
book. 
 
 
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HPA South West Community Infection Control Guidelines 
2nd Edition (2007) 
Table 5 
Routine testing of bench top steam sterilisers42 
 
Traditional Steriliser 
Vacuum Steriliser 
Daily 
Automatic control test: 
Automatic control test: 
-  Operate normal cycle with chamber  -  Operate normal cycle with chamber 
empty except for shelves etc. 
empty except for shelves etc. 
-  Record of temperatures, pressures,  -  Record of temperatures, pressures, 
elapsed time at all significant ends of 
elapsed time at all significant ends of 
the operating cycle 
the operating cycle 

Check door cannot be opened during  - 
Check door cannot be opened 
operation 
during operation 
 
Steam penetration test 
Weekly 
Examine door seals 
Examine the door seal 
Check the security and performance of  Check the security and performance of 
the door safety devices 
door safety devices 
Check safety valves etc. are free to 
Check safety valves etc. are free to 
operate 
operate 
 
Air leakage test (automatic) 
 
Automatic air detection system function 
test 
 
Automatic control test 
 
Steam penetration test                         
Quarterly and annual tests by an engineer 
 
 
B 5.5.6  

Cleaning instruments prior to sterilisation32,36,42 
 
Cleaning is an essential pre-requisite to effective sterilisation; the steriliser 
does not wash or clean equipment. Dirty instruments placed in the autoclave 
may not be sterilised as the contaminant may coagulate and form a barrier, 
which the steam cannot penetrate.  Such instruments must be regarded as 
non-sterile and they must not be used until they have been cleaned 
thoroughly and re-sterilised. (See B 5.2). 
 
A washer-disinfector is recommended for cleaning instruments. After 
cleaning, instruments must be stored dry. 
 
 
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HPA South West Community Infection Control Guidelines 
2nd Edition (2007) 
B 5.5.7  
Loading the steriliser 
 
Sterilisation relies on the contact of steam with all surfaces of the load for a 
given period of time.  Droplets of water may result in cool spots and corrosion, 
and incorrect loading may prevent steam penetrating throughout the load.  
Both will prevent sterilisation.  Therefore: 
 
• 
Instruments must be dry when loaded into the steriliser 
• 
They must not touch each other 
• 
Bowls and receivers should be placed on edge.  This will enable 
steam to displace air upwards and downwards and prevent air 
becoming trapped 
• 
Hinged instruments must be left open 
• 
The machine and baskets must not be overloaded  
B 5.5.8  
Storage of sterilised instruments 
 
Instruments sterilised in a bench top steam steriliser should be used as soon 
as possible after being autoclaved.  They may be stored in a sterilised 
container while awaiting use.  Some instruments need to be sterilised 
between uses to prevent cross infection, but can be used clean at point of 
use. Do not immerse instruments in a chemical disinfectant whilst awaiting 
use. 
 
B 5.5.9  
Use of sterilised instruments42 
 
After sterilisation the steam condenses and the instruments will be wet unless 
the steriliser has an effective drying stage.  Once the door of the steriliser is 
opened the load will quickly become contaminated with airborne particles. 
 
Devices that must be sterile when used e.g. for minor surgery and 
dentistry.  Once sterilised these devices should be used immediately.  If this is 
not possible the instruments may be separated into two cycles, or used within 
3 hours of sterilisation.  If they are not used immediately they should be dried 
in the steriliser using a post-sterilisation drying cycle and covered with a sterile 
towel/lid. 
 
Devices that must be sterilised between uses, but clean when used (e.g. 
speculae for normal vaginal examination).  Once sterilised the instruments 
may be stored in a clean, dry environment. Alternatively, devices once 
sterilised and dry can be placed in pouches (e.g. Steri-pouches) to protect 
them from contamination. 
 
Sterile devices that are transported outside the clinic e.g. dental or 
podiatry instruments used for treatment in the home.  Must be carried in a 
sterilised container or pouch to protect them from contamination.  Ideally they 
should be in individualised sets for each treatment.   
 
Pouches (e.g. Steri-pouches) must only be used in a vacuum steam steriliser.  
If pouches are used in a steriliser they must be thoroughly dry before opening 
the door of the steriliser, because micro-organisms can penetrate damp 
packaging.    
 
 
 
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HPA South West Community Infection Control Guidelines 
2nd Edition (2007) 
B 5.5.10 
Reservoir and chamber management41,42 
 
Poor management of the reservoir and chamber can result in contaminated 
steam being used.  Full guidance is available in HTM 2031.   
• 
Empty, clean and dry the reservoir and chamber when not in use 
• 
Refill the reservoir  (not topped-up) with sterile water for irrigation prior 
to use   
• 
Clean the chamber with sterile water for irrigation before and after use 
and left dry.  
 
B 5.5.11 

Traceability and record keeping42,146 
 
It is important to have good quality record keeping systems in place to provide 
evidence that each steriliser functions correctly and achieves sterilising 
conditions.  The logbook will provide a complete history of the steriliser.  MDA 
DB2002 (06) gives full details of the records that need to be kept. Records of 
every cycle should be kept to demonstrate that the load has been effectively 
sterilised.  If control indicator strips or automatic printouts are used they must 
also be recorded in the logbook.   
 
Tracking and traceability systems that are suitable for the level of procedures 
being undertaken must be in place, e.g. for invasive procedures details of the 
specific cycles on washer-disinfector and sterilisers must be kept in patients’ 
notes.   
 

5.5.12 
Key points for sterilisation of instruments in the 
community 

 
• 
Ensure that decontamination processes comply with the National 
Decontamination Strategy 
• 
Arrange the workflow to keep dirty and sterilised instruments 
separated. 
• 
Clean and dry instruments using a washer-disinfector prior to 
sterilising.   
• 
Wear gloves, apron and eye protection (if required) when cleaning 
instruments. 
• 
Transportable steam steriliser must be suitable for processing the 
intended loads. 
• 
Users of sterilisers must be trained in their use and maintenance  
• 
Sterilisers must be maintained and tested quarterly and annually by a 
qualified engineer. 
• 
User must carry out and record the daily and weekly checks as per 
Table 5
• 
Report any fault immediately to the engineer. 
• 
Empty reservoirs at the end of the session/day 
• 
Replenish reservoirs with sterile water for irrigation prior to next 
session. 
• 
At the end of the session/day, rinse internal surfaces with sterile water 
for irrigation 
• 
Load instruments into the steriliser so that they are not touching. 
• 
Instruments must be sterilised for:  
3 minutes 
at 1340 – 1370 C 
10 minutes 
at 1260 – 1290 C 
15 minutes 
at 1210 – 1240 C 
 
 
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HPA South West Community Infection Control Guidelines 
2nd Edition (2007) 
• 
Instruments that are wrapped or in pouches must only be sterilised in 
a vacuum steriliser. 
• Instruments 
with 
narrow lumens, or porous loads must only  be 
sterilised in vacuum steriliser. 
• 
Do not soak instruments in disinfectants before or after sterilising. 
• 
If a vacuum steriliser is not available send instruments with lumens 
and porous loads to CSSD or use disposables and process other 
instruments unwrapped 
• 
Use instruments as soon as possible after being sterilised. 
• 
Store instruments in a clean, dry, dust free place if they are to be used 
for clean non-sterile procedures. 
• 
Retain records for at least 11 years 
 
B 5.6  Decontamination of Health Care Equipment Prior to Repair,  
Service or Investigation50,51 
 
No equipment that has been contaminated with blood and other body fluids, 
or exposed to patients with a known infectious disease, should be sent to 
third parties without being correctly decontaminated first.  If in doubt, contact 
the third party in advance.  After decontamination and before dispatching the 
item it should be labelled with a declaration of its decontamination status that 
states the method of decontamination used, or reasons why this was not 
possible. (MHRA, 2003)50. 
 
Some equipment cannot be effectively decontaminated without being 
dismantled by an engineer.  In addition decontamination may sometimes 
remove evidence of a fault or hinder an investigation.  In these situations the 
manufacturer, repair organisation or investigating body should be contacted 
for advice regarding packaging and transportation.  A “Biohazard” label 
should be attached to the item, the certificate completed accordingly and staff 
advised on protective measures required. 
 
B 5.7  Home Loans Equipment51 
 
Equipment that has been used in clinical care must be safe to handle before 
returning to the home loans store and the principles outlined above apply 
equally to equipment that is loaned for clinical or social care. 
 
• 
Empty suction machines and rinse suction bottles with warm water 
and detergent, rinse and dry 
• 
If soiled, clean other items with warm water and detergent and dry  
• 
If items cannot be cleaned prior to collection/delivery inform the Home 
Loan Stores Manager so that precautions can be taken. 
• 
When selecting beds, chairs etc for clients who have incontinence 
problems or leaking wounds select items with waterproof covering that 
is easily be cleaned 
• 
Upholstered items that are superficially contaminated may be cleaned 
by wiping with detergent and water or by a steam clean. 
• 
Upholstered items that have been grossly contaminated may need to 
be re-upholstered or destroyed 
• 
Home loans staff involved in collecting used items should wear 
disposable gloves when handling potentially soiled items.   
• 
Remove the gloves once item is loaded and clean hands using alcohol 
wipes/gel or soap and water. 
 
 
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HPA South West Community Infection Control Guidelines 
2nd Edition (2007) 
 
B 5.8  Endoscopes 29,32,52 
 
• 
Endoscopic procedures carry a significant risk of infection and it is 
therefore recommended that endoscopy be not undertaken in 
community settings without first carrying out a comprehensive risk 
assessment.  To reduce the risk of infection to a minimum requires 
excellent decontamination facilities including cleaning, disinfection 
and/or sterilisation procedures. 
 
• 
Should it be considered necessary to introduce a community 
endoscopy service reference must be made the MDA DB2002(05) 
Decontamination of Endoscopes52 and advice sought from the relevant 
hospital and community infection control teams and managers of 
sterile services.  Specific procedures must then be developed which 
are relevant to the location, the type of endoscopy to be undertaken 
and the risk of infection. 
 
• 
Single-use devices are recommended wherever possible and any re-
usable items must be traceable in accordance with Health Service 
Circular HSC2000/03234. 
 
• 
Where disinfectants are used a COSHH assessment29 must be 
undertaken and controls put in place to ensure that the patients, staff 
and visitors exposure to the chemical does not exceed the maximum 
exposure limit (MEL). 
 
• 
Glutaraldehyde is not recommended in community settings.  If it 
should never be used if other appropriate disinfectants are available.  
If its use is unavoidable a number of controls must be in place to limit 
exposure to fumes and contact with the chemical, to manage spillage 
and to monitor staff health. 
 
 
 
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HPA South West Community Infection Control Guidelines 
2nd Edition (2007) 
Table 6 
Decontamination methods and frequencies 
 
For specific advice refer to manufacturer’s recommendations 

 
Item 
Method 
Auroscope ear pieces 
If soiled, remove wax by cleaning with general-purpose 
detergent and warm water (<350C), using a thin brush to clean 
inside. Then disinfect by: 
a)  Immersing in 70% alcohol for 10 minutes or 
b)  Pulling through the lumen a 70% alcohol impregnated 
swab or 
c)  Autoclave to sterilise 
Brushes should be cleaned and dried or discarded 
Baby scales 
Protect from soiling with paper roll. 
Clean with detergent and water if soiled or  
Wipe with an alcohol impregnated cloth 
Basins and taps 
Clean with detergent and water, or cream cleaner, rinse and 
 
leave to dry 
Baths 
As for basins and taps 
Bath mats 
Remove from bath surface.  Immerse in warm water and 
detergent and agitate well.  After each use hang mat reverse 
side up to dry over the side of the bath. 
Baths and showers 
Follow any specific manufacturer’s instructions to clean baths 
and showers.  Spa pools, whirlpool baths, hot tubs etc require 
specific disinfecting procedures 143 
Bed frames 
Wash with warm water and detergent, dry 
Bed cradles 
Wash with warm water and detergent, dry 
Bedpan / commode liners 
Disinfect bedpans/urinals using a washer-disinfector, OR 
Use disposables and discard in a macerator or as low-risk 
clinical waste, OR 
If re-usable wash with detergent and warm water, rinse with 
very hot water and dry using disposable paper towels. Disinfect 
with chlorine-releasing product or alcohol wipe. 
Bins 
Clean with detergent and water 
Birthing pools 
Follow manufacturer’s advice on cleaning and maintenance.  
Avoid contamination of pool water if possible.  Remove any 
debris after use.  Rinse and clean pool after use using 
detergent and warm water.  Disinfect all surfaces and outlets 
with a chlorine-releasing product. Discard disposable hoses. 
Bowls 
Clean with warm water and detergent. Rinse with hot water. 
Store dry, inverted, and above floor level. 
Breast pumps 
Individualise.  Follow manufacturer’s advice. Clean external 
surfaces of machine with detergent and warm water.   
Buckets 
Wash with hot water and detergent.  Dry and store upside 
down. 
Buckets for leg ulcers 
Line with plastic before use, then clean as above 
Carpets 
Vacuum daily.  There should be a schedule for cleaning 
carpets at least six monthly.  The type of floor covering should 
be chosen to enable it to be cleaned regularly.  Spills of body 
substances should be removed using a disposable paper towel 
(wear gloves for this) and then cleaned with carpet shampoo 
 
 
 
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HPA South West Community Infection Control Guidelines 
2nd Edition (2007) 
 
Item 
Method 
Catheter bags 
Discard single use bags every morning 
Single use 
Drain re-usable bags daily; protect the cap.  Change weekly or 
Drainable 
when soiled. 
Catheter stands 
Individualise catheter stands.  Clean with detergent and water 
Catheter supports e.g. 
Individualise.  Follow manufacturer’s guidelines to keep 
sporran, holsters, leg 
socially clean.  Launder if possible or clean with detergent and 
straps 
water. 
Changing mats 
Protect with paper roll.  Clean with detergent and water or 
detergent wipes. If soiling is evident, or if there is an outbreak 
of diarrhoea and vomiting, then apply a chlorine releasing 
product (Precept, Sanichlor or bleach) after cleaning 
Cloths/dusters 
Use disposable if possible.  If not disposable, then machine 
wash daily separately from clothing and store dry.  Do not 
leave to soak 
Commodes (and raised 
Clean all surfaces using warm water and detergent.  If soiling 
commode seats) 
is evident, or if there is an outbreak of diarrhoea and vomiting, 
then apply a chlorine releasing product (Precept, Sanichlor or 
bleach) after cleaning 
Couch  
Cover with paper roll to minimise contamination 
(e.g. treatment rooms) 
Avoid linen, but if used, launder as per Table 7 
Between patients clean with detergent and water or detergent 
impregnated wipe 
For blood and body fluid spills See B 4.5 
If the mattress is contaminated it may need to be re-
upholstered 
Crockery  
Wash using a dishwasher on the hot setting. If washing by 
And cutlery 
hand, use detergent and warm water and a disposable cloth.  
Change the water frequently and rinse with very hot water.  Air-
dry in racks, or use disposable paper towels.  
Tea towels should not be used for drying up. 
Dish cloths 
As for cloths/dusters 
Door handles 
Wash with warm soapy water. In outbreaks more frequent 
cleaning may be needed 
Drains 
Rinse regularly with detergent and water 
Ear syringing water 
Fill the reservoir with 0.1% Sodium Dichloroisocyanurate 
reservoir and tubing* 
(NaDCC), run for a few seconds then allow to stand for 10 
(Propulse) 
minutes.  Empty reservoir and rinse system with fresh water. 
Disinfect system with NaDCC 0.1% for 10 minutes. Flush with 
sterile water and leave dry. 
Ear syringing jet tip 
Remove from tubing and clean tips using detergent and warm 
applicator* 
water, to remove wax.  Wash in hot soapy water and rinse 
under running water.  Soak in 0.1% NaDCC for 10 minutes. 
Rinse and dry 
Ear syringing Jobson 
Send to Sterile Supplies Department.  OR  
Horne Probe* 
Wash in a washer/disinfector then autoclave.  Store dry 
Ear syringing Nootes ear 
As for Jobson Horne Probe. Tank must cool completely before 
Tank* 
next use. 
Ear syringing speculum 
As for Jobson Horne Probe 
for otoscope* 
 
*Copyright Primary Care Ear Centre and Mirage Dental Products 
www.earcarecentre.com
 
 
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HPA South West Community Infection Control Guidelines 
2nd Edition (2007) 
 
 
Item 
Method 
ECG equipment 
Clean with warm water and detergent, if non-immersible wipe 
with a soapy cloth rinsed almost dry.  Store dry. 
Electronic medical devices  Follow manufacturer’s instructions.  In general switch off and 
wipe clean using a soapy cloth or alcohol wipe with a between 
uses 
Examination couch 
 
(see couch) 
Face flannel/ towels 

Flannels and towels must never be shared.  If rooms are 
shared personal towels, etc. should be allocated to each client. 
Dry between uses.  Launder on a hot wash.  In communal 
areas such as toilets, disposable paper towels should be 
provided. 
Family planning 
The Department of health recommends that all items 
equipment 
entering the vagina must be adequately decontaminated 
 
between uses. This can only be achieved by sterilisation 
 
using heat, not by using disinfectants or boiling water 
 
Use sterile, single use items where possible 
Vaginal speculae 
If re-usable, send to a Sterile Supplies Department OR if this is 
Trial size diaphragms 
not possible: 
And intra-uterine fitting 
Clean with warm water and detergent then autoclave and store 
devices 
dry 
Floors 
Ideally, all floors should be vacuumed, whether carpeted or 
not, to prevent dust being dispersed. 
Control dust on uncarpeted floors with an anti-static mop and 
clean with detergent and water when soiled or daily.  Rinse 
and dry. 
Furniture 
Hard surfaces should be damp dusted with detergent and 
water. Disinfect if used by an infected patient 
Vacuum soft furnishings regularly 
If superficially soiled or during outbreaks steam clean  
If grossly soiled the item may need to be re-upholstered or 
thrown away 
Glucose monitoring 
Follow manufacturer’s instructions for cleaning between uses.  
devices 
Use disposable lancets, platforms and devices. 
Growing skills toolkits 
As for toys 
Hair brushes and combs 
Individualise.  Wash in warm soapy water, rinse and dry. 
Hair clippers and scissors  Individualise .  Clean with detergent and water.  If 
contaminated with blood immerse blades in 70% alcohol for 10 
minutes after cleaning. 
Hand (grab) rails 
Wash with detergent and water when cleaning the bath or toilet 
(e.g. toilet/bath) 
Hoists (bath) 

Follow manufacturer’s instructions to clean all surfaces 
 
including back and underneath of hoists after use. 
Hoists (lifting) 
Individualise slings or use disposables, especially if a client 
Slings 
has an infectious disease, Follow manufacturer’s guidelines. 
Launder if possible. 
Injection trays 
Wash with warm soapy water daily, wipe with 70% alcohol 
wipe between uses 
Jugs (measurement of 
Single use.  If re-usable, disinfect in a washer-disinfector or 
urine, hair washing etc) 
clean as for urinals. 
 
 
 
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HPA South West Community Infection Control Guidelines 
2nd Edition (2007) 
 
Item 
Method 
Lancets, scalpels 
Single use only 
Laryngoscopes 
Use single use blades.  If re-usable send to sterile supplies 
department for sterilisation.  Clean handle after use with warm 
water and detergent or alcohol wipe if visibly clean 
Lavatory brushes 
Rinse in flushing water and store dry 
Lavatory seat and handle 
Clean all surfaces using warm water and detergent.  If soiling 
(including raised seats) 
is evident, or if there is an outbreak of diarrhoea and vomiting, 
then apply a chlorine releasing product (Precept, Sanichlor or 
bleach) after cleaning 
Lavatory bowl 
Using a toilet cleaner, clean bowl with a toilet brush. 
Keep toilet brushes clean and dry and in good repair 
Madsen Echoscreen 
Follow manufacturer’s guidance 
White probe 
Use cleaning wire to clean sound channels of the probe tip 
 
from the rear, wiping wire with alcohol before pulling it back 
 
through the sound channel 
 
 
Black acoustic filter discs 
 Discard 
 
 
Coloured silicon ear tips 
 
 
Discard or clean as per manufacturer’s guidance 
Probe housing 
Wipe with alcohol 
 
 
Cable and instrument 
Clean with detergent and water or wipe with alcohol 
Medicine pots 
Wash in a dishwasher OR 
Wash in warm water and detergent, rinse and dry 
Mops (wet) 
All mop heads should be detachable.  
Wash in hot soapy water. Rinse and wring out as much as 
possible. Invert mop to dry completely.   
If used in a clinical setting, launder daily. Otherwise launder 
weekly. Do not leave mop head soaking in water or 
disinfectant 

Mops (dry) 
Vacuum the head or discard after use 
Nail brushes 
Use single use brushes, sterile brushes prior to minor surgery 
Nail files 
Individualise where possible. Remove debris with warm soapy 
water.  Soak in 70% alcohol for 10 minutes. Dry 
Nail clippers /scissors 
Individualise where possible. Remove debris with warm soapy 
water.  Soak in 70% alcohol for 10 minutes. Dry. Use 
disposable clipper heads 
Nebulisers 
Some are single-use only, follow manufacturer’s instructions. 
There is potential risk of legionella transmission from residual 
water in chamber after washing. Follow manufacturer’s 
instructions re washing and replacing nebulisers136. 
Use single patient use tubing.  Discard all disposables. 
Oxygen Masks 
Each mask should only be used on one client and disposed of 
when no longer needed or when soiled.  If attached to an 
oxygen point for emergency use, cover to prevent dust 
collection, and discarded once used. 
Peak flow meters  
Individualise where possible.  If not single-patient use, consider 
using filters for each patient. Replace mouthpiece after use. 
 
 
 
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HPA South West Community Infection Control Guidelines 
2nd Edition (2007) 
 
Item 
Method 
Scissors (clinical) 
For invasive procedures and wound care, use sterile 
disposable or reusable scissors 
For clean procedures e.g. cutting bandages and tape, clean 
regularly with detergent and water or wipe with an alcohol 
impregnated wipe 
Screens 
Clean with warm water and detergent regularly or when soiled. 
Shaving equipment 
Shaving equipment, including wet or electric razors, and 
shaving brushes, must never be shared. Equipment should be 
marked with the client’s name in communal settings.  Clean as 
per manufacturer’s instructions 
Showers 
Clean with bathroom cleanser or detergent and water. 
Descale head regularly 
If shower is out of use for a few days run it on a hot setting for 
5 minutes before next use to avoid legionella 
Launder shower curtains when soiled or every 3 months, 
replace as necessary 
Clean tiles regularly with bathroom cleanser and anti-mould 
product as required 
Spa pools, whirlpool baths,   
hot tubs etc. 
(See baths and showers) 
Sputum cups 

Single use 
Stethoscopes 
Clean as necessary.  If contaminated with body fluids clean 
then disinfect with an alcohol-impregnated wipe (e.g. Steret) 
Suction bottles 
Disposable suction liners are recommended 
Re-usable bottles – wear protective clothing, empty contents 
into a slop-hopper or toilet.  Disinfect bottle using a washer-
disinfector OR 
rinse with cold water.  Clean using warm water and detergent, 
rinse with hot water and store dry 
Suction catheters 
Single-patient use 
Suction machine 
Clean the surface using a soapy cloth, wrung almost dry. 
Replace filters when wet and at appropriate intervals according 
to manufacturer’s instructions 
Suction tubing 
Use single-patient tubing 
  
Rinse with sterile water between uses 
Replace daily 
Surgical, dental or podiatry  Use disposables where possible. 
instruments 
If re-usable, sterilise in a Sterile Supplies Department. OR 
Clean using a washer-disinfector, then autoclave.  Store dry. 
Tea towels 
Use disposable paper where possible, or launder  
Thermometers 
Use disposables or disposable sheaths and discard after use 
Before and after each use wipe with 70% alcohol impregnated 
swab and store dry 
Toilets (see lavatory) 
 
Tooth mugs 
Disposable or client’s own.  Use dishwasher or clean with 
warm water and detergent, rinse with hot water and dry. 
Toys 
Individualise if possible. Launder soft toys and dry quickly.  
Clean hard surfaces with warm soapy water or a hard surface 
disinfectant.  More frequent cleaning may be needed in 
presence of infection. 
 
 
 
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HPA South West Community Infection Control Guidelines 
2nd Edition (2007) 
Item 
Method 
Trolley/tray for dressings 
Clean with detergent and warm water. Dry. 
etc 
Wipe top with 70% alcohol impregnated between patients 
Urinals 
Use disposables where possible 
Re-usable urinals – disinfect in a washer-disinfector. OR if not 
available: 
Wear protective clothing, empty contents into a slop-hopper or 
toilet. Rinse and clean using warm water and detergent or 
chlorine-releasing product.  Rinse in hot water, and store 
inverted to dry thoroughly 
Vacuum  
Filters prevent dust contamination, change as per 
Cleaners 
manufacturer's instructions. Wipe attachment tools with hot 
water and detergent when soiled or weekly 
Vases 
Rinse and remove any debris.  Wash in warm water and 
detergent, rinse and invert to dry thoroughly or use dishwasher 
Vitalograph 
Use non-return mouthpiece and discard after use.  Use an 
approved filter 
Walking frames 
Clean with warm soapy water and dry 
Walls 
Remove splashes etc with warm water and detergent as 
necessary 
Wash basins 
Clean using a suitable cleanser or warm water and detergent.  
Rinse and allow to dry 
Remove scale periodically using a descalent 
Wheelchairs 
Clean with warm soapy water and dry 
Weighing scales 
Line with disposable paper roll and clean with detergent and 
warm water 
Wipe with 70% alcohol impregnated wipe 
Work surfaces 
Clean with hard surface cleaner or warm water and detergent.  
If contaminated with body fluid disinfect with chlorine or wipe 
with 70% alcohol after cleaning 
 
 
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HPA South West Community Infection Control Guidelines 
2nd Edition (2007) 
B 6.0  Laundry 4, 53, 145 
Aim: 
• 
The eradication or reduction in the number of organisms on 
linen/clothing  
• 
Minimise the use of linen where no laundry service is available 
• 
Protection of staff and prevention of cross infection 
B 6.1  Handling used linen 
Linen may be contaminated with bodily fluids and debris.  Inspect the linen 
when removed.  If fouled with body fluids, linen should always be removed 
using gloves and disposable aprons.  Where solid matter is present, this must 
be removed using disposable paper and disposed of in either a WC or slop-
hopper.   
Foul/infected linen should not be handled any more than is absolutely 
necessary. Do not sluice by hand as this may spray micro-organisms onto 
surfaces, uniforms and skin. Soiled or fouled articles should be washed on 
the hottest cycle the fabric will allow.  Those items that are not washable, 
should be dry cleaned or, if necessary, destroyed.  
Bed linen should not be shaken and it must be removed with care, avoiding 
the creation of dust and dissemination of skin scales.  
B 6.2  Colour-coding used linen 
In clinical settings, a laundry service may be available and used and soiled 
linen should be placed into the appropriate colour laundry bag. If a laundry 
service is not available, use paper products where possible.  In residential 
care settings it can be helpful to introduce a colour-coding system.  Assess 
the condition of used linen and clothing to decide which category it falls into.  
See Table 7
Table 7 
Segregation and laundering of used linen 
 
Category  
Description  
Laundering requirements 
Used linen and 
Linen that is used but 
•  White laundry bag  
clothing 
not contaminated with 
•  A sluice cycle is not required.   
urine, faeces, blood, 
•  Launder at 650C for at least 10 
vomit, sputum or any 
minutes, or 700C for 3 minutes 
other bodily fluid or 
•  Or as per care label 
debris 
Foul or 
Linen that is 
•  Remove solid waste  
infected linen 
contaminated by bodily 
•  Place in a red alginate bag using 
and clothing 
secretions or faeces, or 
gloves and apron  
from a person with a 
•  A sluice cycle may be needed 
known infectious 
•  Launder at 650C for at least 10 
condition 
minutes, or 700C for 3 minutes 
Heat sensitive 
Linen that is soiled or 
•  If fouled, disposal may be 
fabrics  
fouled and cannot be 
necessary  
washed at high 
•  Dry cleaning may be possible for 
temperatures 
some items 
 
 
 
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HPA South West Community Infection Control Guidelines 
2nd Edition (2007) 
B 6.3  Laundry practice in residential care settings and client’s home 
• 
Always wash hands after handling used linen 
• 
Gloves must be available for handling fouled linen 
• 
Staff who undertake laundering must receive training 
• 
Laundry must not be sorted on the floor. 
• 
Washing machines and driers should not be sited in kitchens.  This 
may be unavoidable in client’s homes, so avoid doing laundry at the 
same time as the cooking and ensure hands are washed. 
• 
Foul or infected laundry should be laundered after all the other routine 
laundry has been done, using the hottest wash available for that fabric. 
• 
Used linen and fouled/infected linen should not be laundered together. 
• 
The washing machine must not be over loaded to ensure that the 
machine functions adequately. 
• 
Laundry baskets should be cleaned with detergent and water after 
containing soiled or fouled linen, or at least weekly.  
• 
Kitchen items and mop heads must be washed separately. 
• 
Use separate cleaning equipment for the laundry area. 
• 
Disinfect washing machines weekly by running a hot programme 
without a load. 
• 
Prevent contamination of clean linen 
 B 6.4  Laundry facilities in residential care settings 
A separate laundry facility, which is used solely for that purpose is 
recommended for all residential care settings.  However, it is recognised that 
this is not always available in the client’s own home. 
In a clinical environment, a full written risk assessment must be performed of 
all laundering facilities.  The person in charge should regularly review the risk 
assessment. 
B 6.4.1  Wash hand basin    
• 
Lever action mixer taps are recommended 
• 
Liquid soap and paper towels must be available 
• 
A foot-pedal operated bin for paper towels should be provided 
If hand washing delicate materials or other personal items is undertaken, a 
designated sink or bowl, which is separate from the wash hand basin, must 
be used.   
B 6.4.2  
Washing Machines 
An industrial washing machine with a sluice cycle is recommended. Machines 
must be regularly maintained and records retained 
 
 
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HPA South West Community Infection Control Guidelines 
2nd Edition (2007) 
B 6.4.3  
Drying facilities  
Tumble driers are recommended. 
B 6.4.4  
Design of the laundry 
• 
The floor, walls, splash-backs, draining boards etc of the laundry must 
be easily washed with no cracks visible in the surface.  It is advisable 
that floors are non-slip. 
• 
The design of the laundry must facilitate the creation of dirty and clean 
areas i.e. dirty linen can be bought into one area moved through the 
laundry as it is processed and come out as clean laundry without 
crossing over the route for used laundry. 
• 
Any laundry bins should be fully washable and be well maintained. 
B 6.5  During outbreaks in residential care settings 
• 
Hand wash at appropriate times 
• 
Use red alginate linen bags for fouled/infected linen to minimise 
contact.  Alginate bags can be placed directly into a washing machine 
and will dissolve in contact with the water.  Some residue may remain. 
• 
If alginate bags are not available use red plastic bags.  Empty the 
contents into the washing machine without handling and discard the 
bag. 
• 
Minimise the number of people visiting the laundry 
• 
Keep the laundry room and equipment especially clean 
• 
Ensure contaminated linen is kept away from clean linen 
B 6.6  Ozone washing machine (OTEX)  
Otex Validated Ozone Disinfection is a new laundry system that injects and 
dissolves ozone into the wash water throughout the wash cycle.  The 
manufacturers claim that the product kills micro-organisms even at low 
temperatures.  The Health Protection Agency’s Rapid Review Panel 
undertook a review of the product and recommended that, at the time, the 
product was insufficiently validated and more research was needed into its 
efficacy. 
http://www.hpa.org.uk/infections/topics_az/rapid_review/pdf/RRS95_otex.pdf 
 
 
 
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HPA South West Community Infection Control Guidelines 
2nd Edition (2007) 
B 7.0  Disposal of waste54,55,56, 145, 153 
B 7.1  Responsibilities 
The Environmental Protection Act 199055 applies to waste disposal.  This 
legislation refers the Duty of Care, which places a duty of care on all persons 
producing waste to safely manage the handling and disposal of the waste in 
the correct and proper manner.  The following information will help meet the 
duty of care.   Healthcare waste must be managed in accordance with current 
legislation and national guidelines.   
Healthcare organisations should have a waste policy in place, which is owned 
by the senior managers and supported by training and audit.  Under Section 
16 of the Care Homes Regulations, care homes are also obliged to have 
suitable arrangements in place for the disposal of waste. 
This guideline does not contain all the relevant information, so it is advisable 
for managers to refer to the original source documents in developing local 
policy and discuss local policy with their waste manager or Contractor. HTM 
07-01: Safe Management of Healthcare Waste 
can be accessed at: 
http://www.dh.gov.uk/assetRoot/04/14/08/93/04140893.pdf 
For further information refer to the Environment Agency or see: 
 
http://www.nhsestates.gov.uk/sustainable_development.index.asp.  
B 7.2  Waste categories 
The new national guideline introduces the terms “hazardous” and “non-
hazardous” waste.    
 
Examples of Hazardous Waste: 
Examples of Non-Hazardous Waste: 
 
Infectious waste 
Offensive/hygiene waste 
Medicines 
Domestic waste 
Amalgam 
Food waste 
Chemicals 
Packaging 
Batteries 
Recyclates (paper, glass, aluminium) 
Infectious waste has two categories for the purposes of transport legislation: 
Category A: An infectious substance which is transported in a form that, when 
exposure to it occurs, is capable of causing permanent disability, life-
threatening or fatal disease in humans or animals. Highly infectious waste 
includes waste arising from exotic infectious diseases and laboratory cultures; 
Category B: An infectious substance which does not meet the criteria for 
inclusion in Category A.  This constitutes most infectious waste produced in 
healthcare. 
Offensive/hygiene waste: is non-infectious waste arising from healthcare, 
which does not require specialist treatment but may cause offence to those 
coming into contact with it; i.e. human hygiene waste, incontinence products, 
sanitary waste, nappies, plaster casts etc. 
Medicinal waste has two categories: 
1.  Cytotoxic and cytostatic; 
2.  Medicines others than cytotoxic and cytostatic 
 
 
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HPA South West Community Infection Control Guidelines 
2nd Edition (2007) 
Staff must assess waste as it is produced to identify its infectious, chemical 
and medicinal properties and segregate appropriately for disposal. National 
guidelines produce useful flowcharts.  See Table 8 and Appendix 8 for more 
details. 
Table 8 
Segregation and disposal of clinical waste54,55,56, 132, 133, Appendix 8 
 
Type of waste 
Examples 
Container 
Disposal  
Infectious 
Anatomical waste: placenta, tissues, 
Yellow rigid 
Hazardous 
waste  
organs etc, and laboratory waste. 
lidded bin or bag   waste 
(Category A) 
Waste from highly infectious 
incineration  
diseases, e.g. Ebola virus 
Infectious 
Assess for infection risk.  
Orange lidded 
Licensed or 
waste 
Infectious: dressings, swabs, 
bin or bag 
permitted 
(Category B) 
bandages, pads, suction liners, stoma 
treatment 
bags, catheter bags, plastic 
facility or 
disposable instruments (not sharp). 
incineration 
Non-infectious: treat as offensive / 
hygiene waste 
Clinical sharps 
Not contaminated with medicinal 
Orange lidded 
Incineration or 
 
products OR 
sharps container  alternative 
Fully discharged sharps 
treatment 
contaminated with medicinal products 
facility 
(NOT cytotoxic or cytostatic 
medicines) 
Clinical Sharps  Partially or undischarged sharps  
Yellow lidded, 
Hazardous 
 
liquid-proof 
waste 
(NOT cytotoxic or cytostatic 
sharps 
incineration 
medicines) 
container. 
Cytotoxic / 
All contaminated waste 
 
 
cytostatic 
 
 
 
waste and 
Soft waste: including gloves, swabs, 
Yellow bag or 
Hazardous 
sharps 
packaging etc  
lidded bin with 
waste 
 
purple stripe 
incineration 
 
 
Sharps waste: needles, syringes, 
Yellow sharps 
ampoules etc,  
bin with purple 
stripe 
Offensive / 
Non-infectious dressings, swabs, 
Yellow bag with 
Deep landfill 
hygiene waste 
drains, incontinence pads, suction 
black stripe 
liners, stoma bags, catheter bags, 
plastic disposable instruments (not 
sharp).  
Medicines 
Unused drugs and other 
Yellow rigid 
Hazardous 
 
pharmaceutical products.  Never 
lidded box for 
waste 
(Not cytoxics 
discard them into the drainage 
liquids or solids 
incineration 
or cytostatic) 
system.   
Controlled drugs: comply with local 
procedures 
Dental 
Amalgam and teeth containing 
White rigid box 
 
amalgam and 
amalgam fillings  
with mercury 
Recovery 
Mercury 
 
suppressant 
NB Avoid waste by purchasing non-
mercury products 
 
 
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HPA South West Community Infection Control Guidelines 
2nd Edition (2007) 
 
 
B 7.3  Storage of clinical waste  
• 
Pedal bins must be available where clinical waste and contaminated 
household waste are generated. 
• 
Bins must be lined with the appropriate colour liner. 
• 
Remove clinical waste bags when they are three-quarters full or at the 
end of the day, as appropriate. 
• 
Securely tie bags as per local arrangements using tape, clips or tying 
in a swan-neck before removing them from the bin 
• 
Label clinical waste bags and sharps boxes with the address of where 
the waste was produced.  This may be using labelled tape or clips, or 
simply by writing the address or Post Code in permanent marker pen 
onto the bag prior to use. 
• 
Hold bags by the neck and do not throw them. 
• 
Clinical waste should be stored in a designated waste collection point 
or wheeled bin away from residential and food preparation areas.  
Ideally in a lockable fixed or wheeled external bin awaiting collection.   
• 
Bins provided for clinical waste must be kept in a secure locked 
location, that is well-lit, ventilated and marked with warning signs. 
• 
Waste must be collected by a registered carrier at regular intervals 
e.g. weekly 
• 
Waste contractors are under no obligation to remove waste if it 
does not adhere to the duty of care, e.g. packaged and labelled 
correctly. 

B 7.4  Clinical waste and cytotoxic waste from patients’ homes54 
 
Patients and informal carers (partner/spouse, relatives or friends) also need to 
understand waste disposal procedures, if there is any possibility that they 
might have to deal with any of the types of clinical waste mentioned here. 
B 7.4.1 
Infectious waste (dialysis, wounds, diarrhoea etc.) 
Community healthcare workers must assess waste for hazardous properties, 
especially “infectious.” This is based on professional assessment, clinical 
signs and symptoms, prior knowledge of the patient. Wounds should be 
assessed as infectious if they have signs of infection or are being treated with 
antibiotics. Another examples are dialysis waste or infectious diarrhoea of 
patient’s receiving healthcare at home.  Waste products must be disposed of 
using orange sacks/containers and waste collection arranged. 
This collection may be via the local NHS Trust or Local Authority as per local 
arrangements. 
 
 
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HPA South West Community Infection Control Guidelines 
2nd Edition (2007) 
B 7.4.2 Non-infectious waste (dressings, incontinence pads etc) 
Where the waste products of healthcare are assessed as non-infectious; i.e. 
non-infectious wound dressings, incontinence pads etc, the waste should be 
discarded as “offensive/hygiene waste” in a yellow bag with black stripe.   
Small volumes of those healthcare products which may also be used by 
householders; i.e. plasters, pads, small dressings, stoma bags etc may go 
into a black bag and discarded as household waste if the householder 
agrees.  Primary wrappers must be opaque, clear or black and must not be 
yellow or orange as this indicates infectious waste. 
 
B 7.4.3  
Clinical sharps  
 
Patients who use needles at home should be provided with a sharps 
container. Used syringes, insulin pens and ampoules should also be 
discarded in a sharps container.     
 
Sharps containers are listed in Part 1XA of the Drug Tariff and are available 
on FP10. Follow local disposal procedures, e.g. return containers to the 
prescribing surgery for collection prior to incineration when full to the line 
indicated on the container.  The practice (or PCT if it manages waste for the 
practice) will need to apply to the Environment Agency for registration of 
exemption of the Waste Management Licensing Regulations 1994 (as 
amended).  Some Local Authorities are able to collect sharps containers from 
householders, but may levy a charge for this service. 
 
Community healthcare workers giving injections in the home should use a UN 
approved sharps container that is labelled.  When carrying the container, the 
aperture must be temporarily closed to prevent accidental spills.  When it is in 
a vehicle, it must be kept out of sight and not left unattended.  When three-
quarters full the container must be locked and disposed of as per Table 8. 
 
Patients who need to use needles and syringes on an out-patient basis, may 
be provided with a sharps container by the hospital and should return the 
container to the hospital for disposal.   
 
B 7.4.4  
Cytotoxic waste 
 
Cytotoxic waste arising from home care must be placed into an appropriate 
yellow container with purple stripe.   Community healthcare workers involved 
in the administration of cytotoxic drugs in the home should use the waste 
disposal arrangements of their Trust.  If patients self-administer the cytotoxic 
drugs the container should be returned to the hospital or GP surgery as 
agreed. 
 
 
 
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HPA South West Community Infection Control Guidelines 
2nd Edition (2007) 
B 7.5 Management of clinical sharps 147 
 
Clinical sharps include needles, scalpels, stitch cutters, glass ampoules, pen 
injection devices, sharp instruments and broken glass.  The safe handling and 
disposal of sharps is paramount in reducing the risk of exposure to blood-
borne viruses and extreme care must always be taken when using and 
disposing of sharps.   
 
• 
Avoid using sharps, including pen injecting devices when 
administrating medication to patients, wherever possible (e.g. use a 
needle-less system such as Vacutainer for venepuncture or Unistix for 
finger pricking) 
• 
Clinical sharps should be single-use only 
• 
The re-sheathing of used needles is hazardous and must be avoided 
where possible.  If this is unavoidable, select an automatic re-
sheathing needle or use a one-handed technique.  
• 
The user of sharps must discard them directly into a sharps container 
• 
Sharps containers must comply with UN3291 and BS7320: 1990 
• 
Label sharps containers when assembling them 
• 
When carrying a sharps container, or whenever the container is left 
unattended, use the temporary closure to prevent spillage or 
tampering 
• 
Place sharps containers of a suitable size in each location where 
sharps are handled, on a level surface 
• 
Secure containers using brackets attached to the wall or a trolley.  Do 
not place them on the floor, window sills or above shoulder height,  
• 
Assemble containers following manufacturer’s instructions 
• 
Carry them by the handle, do not hold them close to the body 
• 
Do not attempt to retrieve items from a sharps container 
• 
Do not attempt to press down upon sharps to make more room 
• 
Discard when three-quarters full or after 3 months. Lock the container 
using the closure mechanism 
• 
Place damaged sharps containers inside a larger containers, lock and 
label prior to disposal 
• 
If sharps are spilled from the container use a safe technique to retrieve 
them, e.g. a dustpan and brush, and carefully place inside the 
container 
• 
Never use single-patient use devices for more than one patient 
• 
Never put a sharps container inside a clinical waste bag 
B 7.6  Household/domestic waste  
• 
Pedal-operated bins are recommended, though open bins are 
adequate for paper towels. 
• 
Any waste that is not covered under the clinical waste groupings is 
classed as household domestic waste, e.g. wastepaper, cans, bottles. 
• 
This waste must be disposed of through the normal household waste 
stream i.e. black bin liners or dustbins collected by the Local Authority.  
Where possible, recycling or re-using options should be considered. 
• 
Household waste and clinical waste must be kept separate at all times. 
• 
Reducing waste can save money and help to improve the environment 
• 
Ensure patients/clients or their informal carers are aware of the need 
to deal with clinical waste appropriately. 
 
 
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HPA South West Community Infection Control Guidelines 
2nd Edition (2007) 
B 8.0  Single use medical devices3,57,58,59,60 
Packaging of medical devices will indicate whether an item is for single use or 
for single patient use. 
Items labelled “single use only” (see symbol below) must be used only once.  
The manufacturer will not guarantee that any form of reprocessing, (which 
includes washing in soap and water) will not harm or change the safety of the 
device. 
 
 
If the manufacturer advises that it can be used more than once, e.g. “single 
patient use”, the necessary information will be given on the packaging.  It will 
include details of whether it is for re-use only on one patient, the correct 
method of cleaning between uses, and also, how long the item may be safely 
used for. 
Ignoring the advice printed on the packaging and re-using an item (device) 
outside the guidelines given by the manufacturer has legal implications, which 
basically mean that if anything untoward happens as a result of re-use, any 
legal claim can be made against the user, and not the manufacturer. 
Re-use and reprocessing of devices not intended for reuse may constitute 
committing an offence under The Health and Safety at Work Act 1974,3 Part 
One of the Consumer Protection Act 1987,58 The General Product Safety 
Regulations 199459 or The Medical Devices Regulations 199460. 
If the manufacturer’s instructions on single use, or single patient use are 
ignored, the safety, performance and effectiveness of the device are 
compromised and you will be exposing patients/clients and staff to 
unnecessary risk. 
Follow the instructions on the packaging and do not reuse. 
 
 
 
 
 
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HPA South West Community Infection Control Guidelines 
2nd Edition (2007) 
B 9.0 Food 
Hygiene61-66 
B 9.1  Introduction 
All foods are potentially hazardous if they are not handled correctly.  Good 
food handling practices are essential to minimise the risk of food poisoning.  
This is especially important in residential care settings where food is being 
prepared and served to large numbers, and where consumers are at 
particular risk from food borne illnesses.  
Managers and staff must be aware of legislation relevant to food. Hospitals 
and residential care settings should appoint or have access to a qualified 
catering manager.  The main legislation is the Food Safety Act 199062 and its 
related regulations.  
The local Environmental Health Department can advise about rules and 
regulations.  Environmental Health Officers of the local authority in enforcing 
these regulations are entitled to inspect catering facilities in residential care 
homes.    
A useful book to obtain for further information is ‘Industry Guide to Hygiene 
Practice: Catering Guide61. 
Food poisoning can cause serious illness and even death particularly in the 
elderly.  It is important that all people involved in preparing and serving food 
are aware of how to reduce the risk of food poisoning. 
B 9.2  Training 
People who handle or prepare food need an appropriate level of training in 
the principles of food handling depending upon whether they serve food, cook 
food or manage a kitchen.  Training requirements are summarised in Table 9.  
Where clients cook food for themselves, staff must ensure that the individual 
is supported in applying the principles of food hygiene until independence is 
achieved. 
Courses may be provided by local colleges and NHS Trusts, as well as the: 
• 
Royal Institute of Public Health and Hygiene (RIPHH),  
• 
Royal Society of Health (RSH),  
• 
Royal Environmental Health Institute of Scotland (REHIS),  
• 
Society of Food Hygiene Technology (SOFHT) 
• 
Chartered Institute of Environmental Health (CIEH).  
 
Details of what may be included in Stage 1 and Stage 2 training are in Table 
10

Level 1 formal training.  An example of this is undergoing a course such as 
a Basic Food Hygiene Course.  This is typically a 6-hour course, which aims 
to develop a level of understanding of the basic principles of food hygiene. 
Level 2 and 3 formal training.  These courses deal with food hygiene in 
more detail and will cover management issues as well.  Typically level 2 
involves 12 to 24 hours of training and level 3 involves 24 to 40 hours. 
 
 
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HPA South West Community Infection Control Guidelines 
2nd Edition (2007) 
 
Table 9 
National guidelines for food handling training 
 
 
Stage 1 
Stage 2 
Stage 3 
 “The 
essentials 
Hygiene 
Formal 
Formal training 
of food 
awareness 
training  
Level 2 and/or 
hygiene” 
instruction 
Level 1 

Ideally to be 
Before starting 
Within 4 weeks, 
Within 3 
According to 
completed within 
work for the 
or 8 weeks if  
months 
responsibilities 
this time scale 
first time 
part-time 
 
Food handlers 
 
 
 
 
who handle low 


risk or wrapped 
food only 
Food handlers 
 
 
 
 
who prepare 



open, “high risk” 
foods 
Food handlers 
 
 
 
 
who also have a 




supervisory role 
 
 
 
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HPA South West Community Infection Control Guidelines 
2nd Edition (2007) 
Table 10 
Informal (work-based) training 
 
Stage 1 Essentials of Food Hygiene 
 
•  Keep yourself clean and wear clean clothing 
•  Always wash your hands thoroughly: before handling food, after using the toilet, 
handling raw foods or waste, before starting work, after every break, after 
blowing your nose 
•  Tell your supervisor, before commencing work, of any skin, nose, throat, 
stomach or bowel trouble or infected wound.  You are breaking the law if you do 
not. 
•  Ensure cuts and sores are covered with a waterproof, high visibility dressing 
such as a blue plaster 
•  Avoid unnecessary handling of food 
•  Do not smoke, eat or drink in a food room, and never cough or sneeze over 
food 
•  If you see something wrong - tell your supervisor 
•  Do not prepare food too far in advance of service 
•  Keep perishable food either refrigerated or piping hot 
•  Keep the preparation of raw and cooked food strictly separate 
•  When reheating food ensure it is piping hot 
•  Clean as you go.  Keep all equipment and surfaces clean 
•  Follow any food safety instructions either on food packaging or from your 
supervisor 
 
Stage 2  Hygiene Awareness Training  (appropriate to the job) 
 
•  The business's policy - priority given to food hygiene 
•  "Germs" – potential to cause illness 
•  Personal health and hygiene – need for high standards, reporting illness, rules 
on smoking 
•  Cross contamination - causes, prevention 
•  Food storage – protection, temperature control 
•  Waste disposal, cleaning and disinfection – materials, methods and storage 
•  "Foreign body" contamination 
•  Awareness of pests 
 
 
 
 
 
B 9.3   Hazard analysis 
The Food Safety (General Food Hygiene) Regulations 199564 make a specific 
requirement of organisations to undertake a hazard analysis.  This is a 
systematic examination of how food is prepared and how food safety hazards 
are controlled.  
An Environmental Health Officer will periodically inspect kitchens in 
residential care settings. They will expect to see evidence of hazard analysis 
and any records that support it.  They will also ask managers and the staff 
questions about the hazard analysis and how you implement it. 
 
 
 
 
 
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HPA South West Community Infection Control Guidelines 
2nd Edition (2007) 
The main stages of undertaking a hazard analysis are as follows: 
• 
Identify all the things in your food operation which might go wrong 
(hazards) and result in food poisoning or cause injury, (e.g. the 
presence of bacteria in raw meat, or foreign material such as glass or 
plastic in food); 
• 
Decide the points in the food operation at which things can go wrong 
(e.g. places where cross-contamination between raw foods and ready-
to-eat products may occur); 
• 
Decide which of these points are critical to making sure food is safe, 
and therefore must be properly controlled (e.g. the cooking of raw 
meat or the use of sanitised equipment); 
• 
Put in place procedures to stop things going wrong (controls), and 
make sure that you/your staff always carry them out (e.g. cooking 
meat for a set time and temperature which is known to kill all of the 
bacteria right through to the middle of the joint or ensuring that 
equipment has been cleaned and sanitized at proper and regular 
intervals); 
• 
From time to time, you must examine your food business to see if 
anything has changed which might need your control measures to 
change (e.g. new menu dishes may have new hazards and need new 
controls, or new equipment may require different thermostat settings). 
It is helpful to involve key staff in developing a hazard analysis and all staff 
need to know the part that they have to play in making it work. 
B 9.4  Record keeping 
Although in law you do not have to provide documents or record your policies, 
procedures and monitoring records, it would be difficult to show how you are 
meeting this requirement without records or documents.  It would also be 
difficult, if charged with a Food Safety Act offence, to use the defence of Due 
Diligence to show that you have done everything possible to avoid committing 
an offence.  It is important to provide details of procedures and retain 
monitoring records particularly at critical control points. 
The recommended documents/ records that should be retained include:  
• 
Hazard analysis summary 
• Training 
records 
• 
Food temperatures records (e.g. cooking, cold storage, hot holding 
temperatures) 
• Refrigeration 
temperatures 
• Cleaning 
schedules 
• Delivery 
monitoring 
records 
• 
Stock rotation records 
• Pest 
control 
records 
• 
Equipment maintenance schedule 
 
 
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HPA South West Community Infection Control Guidelines 
2nd Edition (2007) 
B 9.5  Infectious diseases in staff9,10 
People are a common source of food poisoning organisms.  Staff who are 
suffering from sickness, diarrhoea or heavy colds should not be allowed to 
work with food.  Staff suffering from discharges from the ears, eyes, nose or 
those who have septic skin conditions should not be allowed to work with food 
either. See A 1.4
Staff should notify their manager before they start their shift if they are 
suffering from such as condition.  The manager must make sure the 
appropriate action is taken, such as excluding someone from work altogether 
or allocating them other non-food duties.  They must be symptom-free for 48 
hours before returning to work.  If they are suffering from a known gastro-
intestinal infection see C 31.0 for exclusion periods. 
B 9.6  Hand hygiene22 
Refer to B 1.0 for more details.  Hand washing should be carried out on 
entering a kitchen and frequently throughout the working day.  It should 
always happen after handling foods or articles that are a source of food 
poisoning bacteria.  Such things include raw meat, raw vegetables, rubbish 
bins, etc.  Hands should also be washed after going to the toilet, taking a 
break, coughing or sneezing in to hands etc. 
Good hand washing requires running warm water, soap (preferably liquid 
antibacterial) and a nailbrush if hands are particularly soiled.  Nailbrushes 
should be single-use.  Hand washing should take about 30 seconds and staff 
should pay attention to all parts of the hands, fingers and wrists.  Hands 
should be dried using clean drying materials.  The best materials are disposal 
paper towels. 
Hand sanitisers can also be used to supplement hand washing.  These 
contain alcohol and dry quickly on the hands.  They can be used where hands 
are only lightly soiled. 
B 9.7  Protective clothing 
In large kitchens (e.g. hospitals and care homes) anybody entering the 
kitchen should wear suitable over-clothing, which may include a clean white 
coat and hat.   
In smaller kitchens or the home setting, a clean plastic apron with sleeves 
rolled up under short-sleeved clothes is adequate.  Staff who leave the 
kitchen to undertake other duties should remove their protective clothing 
before leaving the kitchen. 
No jewellery, perfume or make-up should be worn whilst working with food.  A 
plain wedding ring being the only exception. 
B 9.8  High risk food63-66 
B 9.8.1  
Raw eggs 
Advice from the Department of Health on raw or lightly cooked eggs is that: - 
"Everyone should avoid eating raw eggs or uncooked dishes made from 
them, and vulnerable groups such as the elderly, the sick, babies, toddlers 
and pregnant women, should make sure any eggs they eat are thoroughly 
cooked until the white and yolk are solid.   However, for healthy people there 
 
 
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HPA South West Community Infection Control Guidelines 
2nd Edition (2007) 
is very little risk from eating eggs which are cooked, whether boiled, fried, 
scrambled or poached." 
• 
Once purchased, eggs should be stored in a refrigerator, below 8oC. 
• 
Caterers should continue to increase their use of pasteurised egg, 
particularly for dishes that are not subject to further cooking prior to 
consumption. 
• 
Food hygiene training programmes should pay particular attention to 
the correct handling of eggs, and food containing eggs, and the 
avoidance of cross contamination. 
The Public Health Laboratory Service65 and Food Standards Agency66 have 
advised that: 
• 
Eggs are kept away from other foods, while in shells or when cracked 
• 
Don’t splash egg onto other foods, surfaces or dishes 
• 
Wash and dry hands after touching, or working with, eggs  
• 
Clean surfaces, dishes, utensils etc thoroughly using warm soapy 
water after contact with eggs 
B 9.8.2  
Pâté, soft-ripened cheeses and cook-chill foods 
Listeriosis, a disease which has been associated with the consumption of 
these foods, may be mild or more severe, causing septicaemia, meningitis, 
encephalitis or, if a pregnant woman becomes infected, can harm the 
developing baby.   Elderly people, or those who have impaired immunity due 
to disease or treatment, are particularly vulnerable to infection. 
Particular care needs to be taken in developing diets for vulnerable people; 
they should avoid soft-ripened cheeses and should re-heat cook-chill meals 
and ready-to-eat chicken until they are piping hot.  During the late 1980s 
there was an outbreak of Listeriosis associated with pate, but the difficulties 
with production of this product now seem to have been satisfactorily 
addressed. 
B 9.8.3  
Unpasteurised milk 
Only pasteurised milk and milk-based products, should be offered for 
consumption by clients.   Care should be taken with the delivery site to ensure 
that milk containers (bottles or cartons) are protected and that birds or 
rodents cannot break the seal and allow contamination to occur.  If pests 
have perforated the lid, the entire contents of the bottle must be discarded 
because milk is such a good material for germs to multiply in.  
B 9.8.4  
Under-cooked or raw foods 
Research has shown that meat, which is undercooked and still pink after 
cooking, may cause infection.   It is therefore important that all meat and 
poultry is thoroughly cooked until the juices run clear before being served.   
Piping hot meat is safest; this can only be checked using a probe 
thermometer, with a minimum 750 C being reached during cooking. 
Cooked food kept at room temperature and then re-heated is often implicated 
in outbreaks of food-borne infection.   Such practice is unsafe.   Cold cooked 
meats that are sliced some time prior to consumption may also be associated 
 
 
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HPA South West Community Infection Control Guidelines 
2nd Edition (2007) 
with gastro-intestinal infections if poorly handled and/or left at room 
temperature. 
Shellfish, especially if eaten raw or undercooked, is recognised as being a 
high-risk food.   If served to vulnerable clients, particular care should be taken 
to ensure proper preparation, cooking and handling of fresh, tinned and 
frozen shellfish. 
Salads, fruits and uncooked vegetables are a good source of vitamins, 
minerals and fibre but they need careful preparation to ensure that the risk of 
contamination is reduced.   Because of possible contamination with pesticides 
etc, where possible, fruit and vegetables should have the skin removed 
providing this does not mean excessive manual handling.   Leafy vegetables 
such as lettuce, and fruit, should be washed thoroughly in running water.   All 
fruit and vegetables should be purchased from a reputable supplier. 
B 9.9  Gifts of food 
In residential care settings, visitors should be made aware of the dangers 
posed by the high-risk foods discussed here, and they should inform the 
person in charge of any gifts of food brought in. Gifts of food to clients should 
be appropriately covered, then labelled with the name of the client and the 
date of the gift.   Such gifts should be appropriately stored, e.g. refrigerated 
below 50 C if high risk, and consumed within 24 hours if possible. 
B 9.10 Storage of food 
Food must be stored at the correct temperature and in an appropriate place.  
Most food poisoning germs will grow at temperatures between 5oC and 65oC, 
and poor temperature control is an important cause of outbreaks of food 
poisoning.  Storage needs to take account of this. 
• 
The temperature of foods must be recorded using an accurate probe 
thermometer, which is disinfected before and after each use e.g. using 
probe disinfecting wipes or alcohol-impregnated wipes. 
• 
For all foods there should be careful attention to stock rotation so that 
older stocks are used before new stocks.  Food should be stored in 
the appropriate place as soon as possible after delivery or preparation.   
• 
Dried food such as cereal must be stored in pest proof containers 
above floor level. 
• 
Foods, which need to be kept cool, must be stored in a refrigerator.  
These foods should be kept at a temperature of 5oC or below.  The 
refrigerator must have a thermometer and the temperature should be 
checked daily and recorded.  If the refrigerator temperature is above 
50C this should be reported to the manager so that maintenance or 
repairs can be carried out promptly. Care has to be taken to avoid 
contamination of cooked foods with raw foods, especially raw meat 
and poultry.  These should be stored separately.   
• 
All food must be covered and labelled with the date before it is placed 
in the refrigerator.  Drugs or specimens must not be stored in the food 
refrigerator. 
• 
Frozen foods should be clearly labelled with the date before placing in 
the freezer.  This is essential for efficient stock rotation. 
 
 
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HPA South West Community Infection Control Guidelines 
2nd Edition (2007) 
• 
Hot foods must be kept hot at a temperature of 630C or higher.  
• 
Sandwiches should be prepared as close to the serving time as 
possible (ideally one hour before they are served). They should be 
stored covered in the refrigerator below 5 0 C before serving. 
B 9.11  
Food preparation 
It is best practice, even in the home setting, to have separate areas and 
equipment for the preparation of cooked and uncooked meat and poultry, 
vegetables and salad.  In the domestic setting be sure to explain what you are 
doing and why to the patient/client or informal carer.  They may feel your 
precautions are unnecessary. 
 In hospitals and residential settings, equipment must be labelled or colour 
coded so that cooked food does not become accidentally contaminated with 
raw food.  Germs on raw food (especially meat and poultry) may cause food 
poisoning if they get onto food that is going to be eaten without further 
cooking. 
Some raw foods commonly contain food poisoning germs and they must be 
cooked properly before serving.  Meat and poultry must be thoroughly 
defrosted before cooking to ensure that they reach the correct temperature 
throughout.  Defrosting should take place in a fridge rather than at room 
temperature. 
Raw shell eggs may contain salmonella, and they should not be used in 
dishes where they are not cooked, such as homemade mayonnaise and 
cheesecakes.  Pasteurised egg should be used in these dishes, or 
alternatively use recipes, which do not contain uncooked egg.  Soft boiling or 
poaching may not be adequate to kill all salmonella bacteria. The sick and 
elderly are particularly at risk from salmonella.   
Once prepared, foods should be kept at the correct temperature.  Items that 
require refrigeration should be placed in the refrigerator as soon as possible 
after preparation.  Hot foods should not be left standing at room temperature.  If 
they are not to be served immediately they should be stored in an oven or hot 
plate. Cooked items, which are going to be stored cold (e.g. some joints of 
meat) should be cooled as quickly as possible and then stored in a refrigerator.  
Slicing food and spreading it over a large surface area can hasten cooling. 
B 9.12   
General hygiene 
Deposits of food encourage the growth of micro-organisms and will attract 
pests.  Crockery, cutlery and other kitchen equipment should be cleaned 
using a dishwasher where possible, see  B 5.0 and  Table 6.  Cracked or 
chipped crockery should be discarded. Food waste should be disposed of as 
soon as possible 
Kitchen cleaning must be carried out regularly to prevent a build-up of food 
deposits behind, beneath and inside kitchen equipment.  Spills should be 
cleared up promptly.  Thorough cleaning with a general purpose detergent 
and drying with a clean disposable cloth will be adequate for most surfaces.  
For food preparation surfaces a product that is a combined cleaner/disinfector 
is recommended. 
 
 
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HPA South West Community Infection Control Guidelines 
2nd Edition (2007) 
B 10.0  
Pets67-70 
Clients can enjoy contact with pets and have health benefits from this.  
However there may be infection risks from pets especially if clients are 
particularly vulnerable due to reduced immunity, age, illness or therapy. 
Sensible precautions can reduce the risk to an acceptable level even in the 
home setting.  However, in a client’s home you may be able to make only 
comparatively small changes, or concentrate on such hygiene measures as 
washing your hands and any work surfaces thoroughly. 
• 
In communal settings, a designated person should be responsible for 
looking after the pet.  There should be written cleaning schedules for 
birdcages and aquariums.  
• 
Wash hands after contact with pets. 
• 
Reptiles such as lizards, iguanas etc are very likely to be carriers of 
exotic strains of salmonella that can be a health risk to young children.  
Children under five should not have contact with such reptiles or the 
environment in which the reptiles live or exercise. 
• 
After animal scratches or bites, clean the area thoroughly by washing 
with soap under a running tap.  Record the injury in the accident book. 
Seek medical advice for bites, which break the skin and for any bites 
or scratches which do not heal quickly or which appear infected. 
• 
If pets appear unwell seek veterinary advice. Ensure pets receive 
regular veterinary care, vaccinations etc, where appropriate. 
• 
Pet feeding areas should be kept clean.   Pets should have their own 
feeding dishes, which should be washed separately from dishes and 
utensils used by people.    
• 
Keep pets out of the kitchen and away from all surfaces where food is 
prepared or consumed. 
• 
Keep opened pet food containers away from food for human 
consumption 
• 
Food not consumed within 20 minutes should be removed or covered 
to prevent attracting pests 
• 
Bedding should also be cleaned regularly and insecticides used as 
necessary to control fleas; advice should be sought from the vet if 
problems occur. 
B 10.1  
Litter box care 
• 
Pregnant women should avoid cleaning out the litter box 
• 
Always wear gloves and a protective apron when cleaning the litter 
box. 
• 
Always wash hands after cleaning the litter box. 
• 
Fit a disposable liner to the box for easy cleaning. 
• 
Use a leak-proof litter box 
• 
Change the litter daily if soiled. 
 
 
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HPA South West Community Infection Control Guidelines 
2nd Edition (2007) 
• 
Seal litter in a plastic bag and dispose of with household waste 
• 
The litter box should not be sited near food preparation, storage or 
eating areas. 
• 
Do not use the kitchen sink or hand washbasin for cleaning litter 
boxes.  Wash well using water and detergent, then fill with boiling 
water and leave to stand for at least 5 minutes to kill toxoplasma eggs 
and other micro-organisms. Finally leave to dry or dry with a 
disposable cloth or paper towel. 
•  Certain animals are more likely to carry diseases that may spread to 
humans: 
o Stray 
animals 
o Sick 
animals/birds 
o Wild 
animals/birds 
o  Animals with diarrhoea 
o Exotic 
animals 
o Cage 
birds 
o Tropical 
fish 
o  Domestic pets who hunt and eat rodents or birds 
o  Reptiles (iguanas, lizards etc) carry exotic salmonella species that 
may be harmful to children under five or other vulnerable adults 
 
Good general hygiene and hand washing are essential for risk reduction.   By 
ensuring that all the above advice is followed, the physical and psychological 
benefits of having pets should improve the quality of life of the clients. 
 
 
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HPA South West Community Infection Control Guidelines 
2nd Edition (2007) 
B 11.0 Visits to farms, zoos and other animal centres by children71 
A number of infections can be acquired during visits to farms and similar 
centres.  These infections can include Escherichia coli 0157, campylobacter, 
salmonella, cryptosporidiosis etc.  They are usually acquired by contact with 
animals, their excreta or contaminated environment.  Children under the age 
of five years, or those who cannot manage their own hygiene needs are 
particularly at risk. 
A range of simple precautions can help to prevent infection.  These include: 
• 
Check the farm is well managed and that the grounds and public areas 
are as clean as possible.  Note that manure, slurry and sick animals 
pose a particular risk of infection and animals must be prohibited from 
any picnic area 
• 
Check that the farm has washing facilities that are adequate and 
accessible for the age and size of the children, with running water, 
liquid soap and disposable paper towels or hot air dryers.  Any 
drinking water taps should be provided away from animals and toilets 
• 
Do not allow children to eat or drink anything, including crisps, sweets, 
chewing gum etc, while touring the farm.  They should also avoid 
putting their fingers, pens or crayons in their mouths because of the 
risk of infection 
• 
If children are in contact with, or help to feed, farm animals they must 
be warned not to kiss animals, put their faces against the animal or 
taste the animal feed 
• 
Everyone must wash and dry their hands after contact with animals 
and also before eating or drinking 
• 
Meal-breaks or snacks should be taken well away from areas where 
animals are kept, and pupils warned not to eat anything which may 
have fallen to the ground 
• 
Any fruit or vegetables produced on the farm should be thoroughly 
washed in drinking water before consumption 
• 
Children should not consume unpasteurised produce e.g. cheese or 
milk 
• 
Hands must be washed before departure 
• 
Ensure that footwear is as free from faecal matter as possible 
• 
Pregnant women should remember that there is a particular risk of 
transmission of infection during the lambing season. 
Adapted from Dept of Health (1999)71 Guidance on infection control in 
schools and nurseries (poster).   
 
Also visit the HSE website: www.hse.gov.uk/pubns/ais23.pdf 
 
 
 
 
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HPA South West Community Infection Control Guidelines 
2nd Edition (2007) 
B 12.0  
Deaths of clients in the community 
If the death occurred from a serious infectious condition that may have public 
health implications, the clinician should inform the Health Protection Unit at 
the earliest opportunity.  Even anticipated deaths may give rise to enquiries, 
and it is easier for the Health Protection Team to deal with these if they have 
already received information. 
B 12.1  
Handling bodies11,72 
It is important to consider the cultural elements concerning death and 
preparation of bodies.  Refer to any local policies or discuss this with the 
client, family or informal carers even before death of possible.  Inappropriate 
handling may be greatly offensive.   
Most bodies pose little risk of infection but sensible precautions will reduce 
the risks even further.  Disposable gloves and apron should be worn when 
washing and preparing the body. 
Clean dressings should be applied to any wounds or leakage sites and 
secured with tape or a loose bandage to prevent any further leakage from the 
site.  The use of pins should be avoided since they present a potential hazard 
to others. 
It is important to contact the undertaker as soon as the death has been 
certified, because the body needs to be moved to a cool environment as soon 
as possible.  Decomposition occurs rapidly, particularly in hot weather or an 
overheated room, and may create a bacterial hazard and be unpleasant for 
those handling the body. 
If it is anticipated that there may be a delay in certifying the death for some 
hours, it could be helpful to forewarn the undertaker so that plans can be 
made to collect the body later.  Cool the room where the body lies, by turning 
off radiators and opening a window. 
Dressings, drainage tubes etc should be removed before the body is 
transferred to the undertaker unless  a Coroner’s post-mortem is likely.  
Inform the undertaker if the body has a pacemaker fitted and if there is a 
known, or suspected, infection hazard. 
In the event of a Coroner’s post-mortem, any tubes must be plugged and 
covered with a dressing pad and secured to the body with tape or bandage. 
 
 
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HPA South West Community Infection Control Guidelines 
2nd Edition (2007) 
B 12.2  
Last Offices for infected people6,11,72,73 
Following the death of an individual with an infectious disease, the 
precautions carried out prior to death must be continued after death since the 
body may remain infectious.  However, any cultural traditions must be 
respected, having been identified in the assessment on arrival. 
• 
When laying out a body, wear disposable gloves and apron   
• 
If the infectious disease presents a serious infection hazard to others 
(e.g. the diseases listed below) the body should be placed in a shroud 
(or own clothes) and then into a plastic body bag, which should be 
carefully secured.   
• Typhoid 
fever 
• Paratyphoid 
fever 
•  Acquired Immune Deficiency Syndrome (AIDS) 
• Tuberculosis 
•  Transmissible spongiform encephalopathies e.g. Creutzfeldt Jakob 
Disease 
The identity labels and Notification of Death labels should be attached so that 
they can be read through the body bag.  A “danger of infection” label and a 
Notification of Death label should be attached discreetly to the outside of the 
bag.  No label should state the diagnosis, which is confidential information.  
The undertaker must be informed of the danger of infection, but without 
disclosure of the diagnosis.  Once the body is in the body bag, those handling 
the bag no longer require the protective clothing. 
Relatives and friends who wish to view the body should do so as soon as 
possible after death.  A member of staff wearing gloves and an apron can 
open the bag. 
It must be understood that there are provisions under the Public Health 
(Control of Disease) Act 198473 to prevent contact with the body of a person 
dying with a notifiable infectious disease.  Relatives should be informed of 
any risk of infection, though in most cases the risk is small and no greater 
than when the deceased was alive. 
The embalming of bodies infected with hepatitis B and C, HIV or CJD, is not 
recommended. 
 
 
 
 
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HPA South West Community Infection Control Guidelines 
2nd Edition (2007) 
B 13.0  
Sharps and inoculation injuries and bites8,11,12, 13,14, 153 
NB 
Follow your organisation’s inoculation injury policy.  
B 13.1  
Risk assessment 
B 13.1.1 
Sharps include: 
Needles, scalpel blades, stitch cutters, cannulae etc used in clinical care.   
These may become contaminated with blood or high-risk body fluids during 
use and there is a risk of accidental injury if not handled correctly. 
B 13.1.2 
High-risk inoculation injuries include: 
• 
Inoculation with an instrument such as a needle or scalpel blade, 
which has been contaminated with blood, or one of the "high-risk" 
body fluids listed below. 
• 
Contamination of mucous membranes (eye or mouth) or breaks in the 
skin with blood, or another "high-risk" body fluid listed below. 
• 
A human bite, if the skin is broken 
 
B 13.1.3 
High-risk body fluids include: 
 
Blood and blood products  
 
Semen and vaginal secretions 
Peritoneal fluid  
 
 
Pericardial fluid 
Synovial 
fluid 
 
   Pleural 
fluid 
Amniotic 
fluid 
 
   Breast 
milk 
Unfixed (and donated) organs and tissues 
 
In relation to blood-borne infections, urine, faeces, vomit, sweat, tears, skin, 
sputum are not considered to be high risk, unless they are bloodstained. 
The risk of transmission of a blood-borne virus is associated with inoculation 
of an infectious dose of  infected body fluid into a susceptible recipient.  
A simple injury, which does not break the skin, or does not involve the 
inoculation of body fluid, is unlikely to lead to the transmission of infection.  
The infecting dose may be as low as a visible drop of blood. However other 
individual factors may affect the risk of transmission. 
Human bites very often become infected due to the large amount of bacteria 
present in saliva, therefore check the wound daily for any signs of bacterial 
infection and inform GP if present.   
 
 
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HPA South West Community Infection Control Guidelines 
2nd Edition (2007) 
B 13.2  
Prevention of sharps / bites and inoculation injuries13,135,147 
 
Action 
Rationale 
Always use an approved British 
To prevent sharps being discarded 
Standard sharps container 
inappropriately 
Ensure it is correctly assembled and 
Prevents the container becoming 
labelled with the name of home/centre 
disassembled and spillage of contents.  
etc. 
Labelling allows identification in the 
event of spillage. 
Take it with you when dealing with 
To enable sharps to be disposed of 
sharps e.g. when giving an injection 
directly after use. 
Place sharps directly into sharps box 
To reduce the chances of injuries 
whilst carrying sharps. 
Never re-sheath needles 
Reduces the possibility of injury. 
If re-sheathing is unavoidable: 
Use an automatic re-sheathing needle 
or  
A single handed re-sheathing 
technique or  
A re-sheathing device 
Do not fill the container beyond line 
Reduces the possibility of the 
indicated before sealing and disposing 
container bursting if dropped or of 
of clinical waste 
sharps protruding and therefore the 
possibility of injury 
Cover all cuts and abrasions 
Avoids contact with blood/body fluids 
Wear gloves and/or eye protection 
Reduces the possibility of contact with 
when handling blood or if there is a risk 
blood 
of splash into the face 
Avoid situations where biting may 
Avoids injury 
occur 
If biting is likely wear long sleeves and 
Makes penetration more difficult 
gloves for contact or even arm guards 
and gauntlets in a high risk situation 
Consider using an insulin syringe and 
Avoids re-sheathing the device 
needle rather than a pen system if the 
client is unable to inject him/herself. 
 
 
 
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HPA South West Community Infection Control Guidelines 
2nd Edition (2007) 
B 13.3 
Action to be taken following sharps injury, inoculation 
injury or a bite 

 
 

 
 
Bleed it 
 
 
encourage bleeding 
 
 
 
 
Wash it 
 
 
under running water 
 
 
 
 
Cover it 
 
 
with a waterproof dressing 
 
 
 
 
Report it 
 
 
To the senior member of staff on duty 
 
 
 
 
Record it 
 
 
in the incident book 
•  Seek advice from A&E or on-call 
 
 
 
person for PEP at the local District 
Inform 
 
General Hospital 
Occupational Health, GP (or visit A&E) 
•  Can source be identified? 
and client’s carer 
•  Is source likely to be infected with 
 
 
 
hepatitis B, C or HIV? 
Assess 
 
•  Can a sample be obtained? 
risk of hepatitis B & C or HIV 

 
  Was it a high-risk injury? 

 
 
 
  Was a high-risk body fluid 
inoculated? 
Obtain 
 
•  What is the immune status of the 
relevant blood samples from source and 
exposed person? 
recipient with informed consent 
•  How much time has elapsed 
 
 
 
between injury and follow-up? 
Specialist will consider 
 
•  Would side effects of Prophylaxis 
The need for post-exposure prophylaxis 
outweigh the possible benefit 
(PEP) or follow-up for Hepatitis B & C or 
HIV 
 
 
 
 

 
 
 
Observe wound 
 
 
For signs of infection and inflammation 
 
The injured person should visit A&E or contact Occupational Health or their 
GP as soon as possible.  Blood may need to be taken from the injured party 
and the source, if known.  Specimens should be sent to the laboratory with 
minimum delay. 
 
 
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HPA South West Community Infection Control Guidelines 
2nd Edition (2007) 
B 13.4 
Post-exposure Prophylaxis for healthcare and public 
sector workers8,11,12,14, 153
 
B 13.4.1 
HIV 
The Department of Health has issued guidelines on HIV Post-exposure 
Prophylaxis (PEP) for health care workers.  Although HIV PEP is 
recommended for health care workers, the risk of transmission is very small 
and requires the inoculation of a significant volume of infected body fluid.  The 
side effects of the treatment may also outweigh any potential benefit. 
Following incidents where the source of the injury is thought to be high risk for 
HIV infection, the injured party should go immediately to Accident and 
Emergency to be assessed. The decision to administer PEP will be taken by 
the consultant on call for PEP e.g. the medical microbiologist, haematologist, 
virologist or occupational health physician at the local District General 
Hospital. 
If recommended, a course of PEP must be started as soon as possible after 
the incident.  Ideally this would be within one hour if there were a high risk of 
exposure to HIV.  However, PEP may be commenced up to 2 weeks after the 
injury if circumstances change, for example if the source of the injury is 
subsequently found to be HIV positive.  The PEP specialist should advise 
pregnant women, who may have been exposed to HIV, regarding the risks 
and benefits of HIV PEP. 
B 13.4.2 
Hepatitis B 
If the source of the injury is a known, or suspected to be, hepatitis B positive, 
Occupational Health or the GP should consider giving hepatitis B vaccine 
and/or immunoglobulin to the recipient of the injury.  This should be 
administered ideally within 48 hours of the injury, though it can be given up to 
7 days after the incident if necessary. 
B 13.4.3 
Hepatitis C 
Where possible an attempt should be made to assess the HCV status of the 
source.  An initial blood sample should be taken from the injured person and 
sent to the laboratory to be stored. If the source is found to be positive, the 
injured party should also be investigated for subsequent sero-conversion and 
appropriate referral made as per Part F, Appendix One. There is currently no 
vaccine available for hepatitis C. 
Following an incident a review of the event should be undertaken in order to 
identify if the injury could be avoided in future. 
B 13.5  
Post exposure prophylaxis for the general public8,12 
Members of the public may be accidentally exposed to blood via inoculation 
or contamination of the eye, mouth or fresh cuts, or as a result of rape, 
condom breakage or sharing drug-injecting equipment.  As a first aid measure 
contaminated skin should be washed with soap and water, or mucous 
membrane flushed with fresh water or saline and medical advice sought.  The 
medical practitioner should carry out an individual risk assessment of the 
circumstances of exposure. 
 
 
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HPA South West Community Infection Control Guidelines 
2nd Edition (2007) 
B 13.5.1 
HIV 
The risk of transmission of HIV as a result of incidents in the community is 
small.  It is also unlikely that Post Exposure Prophylaxis for HIV could be 
administered within 1 hour of exposure.  Therefore for a number of reasons 
PEP may not be appropriate for members of the general public.  If the doctor 
considers the individual to be at high risk of HIV infection they should seek 
urgent advice from a physician experienced in the treatment of HIV and the 
use of PEP. 
B 13.5.2 
Hepatitis B 
Blood-exposures if possible an attempt should be made to assess the HBV 
status of the source.  Following a risk assessment, it may be decided to 
immunise the injured party using an accelerated course of hepatitis B 
vaccine, if they are not already immunised (see Part F, Appendix One)
Sexual partners of someone who has developed acute hepatitis B infection 
should be offered post exposure prophylaxis as per Part F, Appendix One.   
Babies born to mothers who are hepatitis B carriers, or who had acute 
hepatitis B infection during pregnancy: 
•  Mother HBsAg positive 
Baby should receive an accelerated 
course of hepatitis B vaccine 
•  Mother HBeAg positive, or where e-marker is undetermined.  
Baby should receive hepatitis B immuno-globulin and start a course of 
vaccine, given at a contra-lateral site at the same time. 
B 13.5.3 
Hepatitis C 
If possible an attempt should be made to assess the HCV status of the 
source.  If positive, the injured party should also be investigated for 
subsequent sero-conversion and appropriate referral made as per Part  F 
Appendix One. There is currently no vaccine available for hepatitis C. 
 
 
 
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