General Practice

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Name

Job Title

Preventing

Infection Workbook and Guidance for

General Practice

2nd Edition

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Contents Page Tick when completed

1. Introduction 4

2. Infection prevention and control 5

3. Standard precautions 10

4. Hand hygiene 11

5. Personal protective equipment 17

6. Sharps management 21

7. Blood and body fluid spillages 25

8. Waste management 29

9. Laundry 33

10. Decontamination of equipment 35

11. Isolation 39

12. Environmental cleanliness 41

13. Aseptic technique 43

14. Specimen collection 47

15. Viral gastroenteritis/Norovirus 51

16. Clostridium difficile 54

17. MRSA 59

18. PVL - Staphylococcus aureus 63

19. MRGNB 67

20. CPE 69

Commentary 73

Key references 74

Certificate of completion 75

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Preventing Infection Workbook and Guidance

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1. Introduction As a community NHS Infection Prevention and Control (IPC) team

based in North Yorkshire, our aim is to support the diversity of health

and social care providers in promoting best practice in infection

prevention and control. Now in its 2nd edition, this Workbook for

General Practice complements a range of educational infection

prevention and control resources which can be viewed at:

www.infectionpreventioncontrol.co.uk

This Workbook and Guidance is intended to be the foundation for

best practice for infection prevention and control. By applying the

principles within the Workbook you will demonstrate commitment to

high quality care and patient safety. The Francis Report 2013 states

“It is unacceptable for a patient to be injured by contracting certain

types of infection as a result of the failure to apply methods of

hygiene and infection control accepted by a specified standard-

setting body, preferably NICE”. The Workbook and Guidance is

aimed at all staff working in a General Practice, this includes not

only front-line clinical staff, but all staff groups including receptionists

and cleaning staff.

The Workbook has been designed to be undertaken in stages. This

will allow you to complete the ‘Test your knowledge’ questions

before moving on to the next section. On completion, your manager

will check that you have achieved 100% competency in your

infection prevention and control knowledge and then sign the

‘Certificate of completion’. You should keep the Workbook as

evidence of learning and as an on-going reference guide to provide

you with easily accessible advice for day-to-day care of patients.

The Workbook is evidence-based and includes latest national

guidance. Completion of this Workbook also helps your General

Practice demonstrate compliance with the Health and Social Care

Act 2008 and Care Quality Commission requirements in

relation to infection prevention and control training.

Dr Richard Hobson

Director of Infection Prevention and Control/

Consultant Microbiologist

Harrogate and District NHS Foundation Trust

1.

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2. Infection prevention and control The Health and Social Care Act 2008: Code of Practice on the

prevention and control of infections and related guidance

(Department of Health, January 2015), states that, “Good

infection prevention (including cleanliness) is essential to ensure

that people who use health and social care services receive safe

and effective care”.

Infection prevention and control is a key priority for the

Department of Health, reinforced with the standards set out in

the Health and Social Care Act 2008 and the Care Quality

Commission (CQC) requirements. Infection prevention and

control spans the five key questions the CQC will be asking

about your service:

How safe? How effective? How caring?

How responsive? How well-led?

An infection occurs when micro-organisms enter the body and

cause damage. These micro-organisms can come from a

variety of sources and often take advantage of a route into the

body provided by a wound or an invasive medical device, e.g.,

catheter.

Some infections can reach the bloodstream. When this occurs it

is known as a bacteraemia, which can cause serious or life

threatening infection and can result in death.

Infection prevention and control means doing everything

possible to prevent infection from both developing and spreading

to others. Understanding how infections occur and how different

micro-organisms (germs), such as bacteria, viruses and fungi,

spread is essential to preventing infections.

Healthcare associated infections

The term healthcare associated infection (HCAI) refers to

infections associated with the delivery of healthcare in any

setting, e.g., hospitals, GP surgeries, care homes, in a

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Vaccines Vaccines can prevent transmission of disease from person-to-

person by both patients and staff. Staff should be aware of their

immune status in accordance with the guidance Immunisation

Against Infectious Disease (The Green Book) Chapter 12.

Correct storage of vaccines is essential to maintain their efficacy. If

vaccines are not stored correctly they may lose their effectiveness.

Over time vaccines naturally biodegrade and storage out of

temperature may hasten the loss of potency. This may result in the

vaccine failing to create the desired immune response, thereby

providing poor protection. Practices should ensure vaccines are

stored in line with the guidance in The Green Book or local Vaccine

Cold Chain Policy.

FACT

Every year there are over 300,000 cases of healthcare

associated infection (HCAI) in England and it is thought that up

to 30% of HCAIs are preventable.

In 2007, there were 9,000 deaths due to HCAI in both hospital

and primary care settings in England.

This costs the NHS £1 billion a year and £56 million of this is

estimated to be incurred after patients are discharged from

hospital.

Antimicrobials It is important to ensure appropriate antimicrobial use to optimise

patient outcomes and to reduce the risk of antimicrobial resistance.

General Practice prescribing accounts for 80% of NHS antibiotic

use and this antibiotic use must be both necessary and appropriate.

Antibiotics should not be prescribed for viral infections.

The Antimicrobial stewardship: systems and processes for effective

antimicrobial medicine use (NICE Guidance NG15, August 2015)

recommends that GPs and nurse prescribers “should support the

implementation of local antimicrobial guidelines and recognise their

importance for antimicrobial stewardship”.

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Chain of infection showing how MRSA can be spread

Case study: Mr Brown aged 92, has a leg ulcer which is

colonised with MRSA. A practice nurse dresses the wound and

does not wash her hands after removing her apron and gloves.

She then attends to 85 year old Mrs Smith who has a small wound

on her ankle. She transmits MRSA to her when cleaning the

wound and applying a new dressing.

Three days later Mrs Smith is very

unwell and is admitted to hospital with

MRSA bacteraemia (a life threatening

bloodstream infection).

Example of how to break the chain of MRSA infection

How to break the link

Hand hygiene

How to break the link

Hand hygiene

Patients with non-intact skin, e.g., wounds

MRSA

Leg ulcer wound

Wound exudate

Via hands

Skin wound, e.g., ankle wound

Organism

Means of transmission

Reservoir

Portal of

entry

Peo

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t

risk

Port

al o

f

exit

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4. Hand hygiene Evidence and national guidance identifies that effective hand

hygiene results in significant reduction in the carriage of

potential pathogens (harmful micro-organisms) on the hands.

Effective hand hygiene decreases the incidence of healthcare

associated infection (HCAI) leading to a reduction in patient

morbidity (disease) and mortality (death).

Hand hygiene is the single most important way to prevent the

spread of infection. Hands may look visibly clean, but micro-

organisms are always present, some harmful, some not.

Removal of transient micro-organisms is the most important

factor in preventing them from being transferred to others.

Hands may become contaminated by direct contact with a

patient, handling equipment and contact with the general

environment.

Hand hygiene refers to the process of hand decontamination

where there is physical removal of dirt, blood, body fluids and

the removal or destruction of micro-organisms from the

hands.

There are two categories of micro-organisms present on

the skin of the hands

Transient bacteria are found on the surface of the

skin. They are called ‘transient’ as they do not

routinely live on the hands. They are transferred to

hands after contact with patients or the environment

and are easily removed by routine handwashing with

liquid soap and warm water.

Resident bacteria are found on the hands in the deep

layers and crevices and live on the skin of all people.

They play an important role in protecting the skin from

harmful bacteria and are not easily removed by routine

handwashing with liquid soap and warm water.

Tra

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Eye protection

Safety glasses or a visor should be worn when there is a risk

of splashing of blood and/or body fluids to the eyes to prevent

infection. Reusable eye protection should be decontaminated

after each use (see section 10, page 35).

Masks

A splash resistant surgical mask should be worn when there

is a risk of splashing of blood and/or body fluids to the nose

or mouth. Masks may be required to be worn on other

occasions, e.g., in the event of pandemic flu.

5.

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White Clinical tasks, e.g., wound dressing.

Yellow Cleaning of treatment and minor operation rooms.

Blue Cleaning of general areas, e.g., consulting rooms.

Red Cleaning of sanitary areas.

Green Cleaning of kitchen areas.

Order for putting on PPE Order for removing PPE

Pull apron over head and fasten at back of waist.

Secure mask ties at back of head and neck. Fit flexible band to nose bridge.

Place eye protection over eyes.

Extend gloves to cover wrists.

Grasp the outside of the glove with opposite gloved hand, peel off. Hold the removed glove in the gloved hand. Slide the

fingers of the ungloved hand under the remaining glove at the wrist and peel off.

Unfasten or break apron ties. Pull apron away from neck and shoulders lifting over head, touching inside of the apron only. Fold or roll into a bundle.

Handle eye protection only by the headband or the sides.

Unfasten the mask ties—first the bottom, then the top. Remove by handling ties only.

Clean your hands before putting on and after removing PPE.

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In the event of a needlestick/sharps injury

1. Encourage bleeding of the wound

by squeezing under running

water (do not suck the wound).

2. Wash the wound with liquid soap

and warm water and dry.

3. Cover the wound with a

waterproof dressing.

4. Report the injury to your manager

immediately.

5. Immediately contact your GP or Occupational Health

department. Out of normal office hours, attend the nearest

Accident and Emergency (A&E) department.

6. If you have had a needlestick/sharps injury from an item

which has been used on a patient (source), the GP in

charge of their care may take a blood sample from the

patient to test for hepatitis B, C and HIV (following

counselling and agreement of the patient).

7. At the GP practice/Occupational Health/A&E department:

a blood sample will be taken from you to check your

hepatitis B vaccination/antibody levels and you will be

offered immunoglobulin if they are low. The blood

sample will be stored until results are available from the

patient’s blood sample. If the source of the sharps

injury is unknown, you will also have blood samples

taken at 6, 12 and 24 weeks for hepatitis C and HIV

if the patient (source) is known or suspected to be HIV

positive, you will be offered Post Exposure HIV

Prophylaxis (PEP) treatment. This should ideally

commence within 1 hour of the injury, but can be

given up to 2 weeks following the injury.

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7. Blood and body fluid spillages Blood and body fluids may contain a large number of micro-

organisms, which should be made safe immediately following

any spillage of blood or body fluids. Dealing with a spillage

may expose the member of staff to infection, therefore,

appropriate personal protective equipment should be worn

and standard precautions followed.

Blood/blood stained body fluid spillages

Disinfect spillages promptly and clean the affected area (see

table below). All blood/blood stained body fluid spillage

waste should be disposed of as infectious waste.

Best practice is to use a chlorine-based blood spillage kit,

which should be used following the manufacturer’s guidance.

Alternatively, use chlorine-based granules as below. * See note on page 27 regarding use on soft furnishings and carpets.

Action for blood/blood stained body fluid spillages 10,000 parts per million (ppm) available chlorine granules

Use Sodium Dichloroisocyanurate (NaDCC), e.g., Haz-Tab or Actichlor granules, as per manufacturer’s instructions.

1. Wear a disposable apron and gloves (PPE).

2. Ventilate the area, e.g., open windows and doors, as fumes will be released from the chlorine.

3. Sprinkle granules directly onto the spillage. Leave for the required contact time which is specified on the container.

4. Clear away the granules and dispose of as infectious waste.

5. With a disposable cloth, wash the area using detergent and warm water, then dry with paper towels.

6. Dispose of cloth and paper towels as infectious waste.

7. Remove PPE and dispose of as infectious waste.

8. Wash hands thoroughly to prevent the risk of transmission of infection.

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Colour stream Description

Orange Infectious waste, which contains infectious

materials from known or suspected

infectious source, e.g., contaminated PPE,

contaminated dressings, very small pieces

of body tissue.

Waste from blood and/or body fluid

spillages.

Infectious waste may be treated to render it

safe prior to disposal, or alternatively it can

be incinerated.

Purple Cytotoxic and cytostatic waste, e.g.,

hormone or oxytocin-based agents.

Cytotoxic and cytostatic waste must be

incinerated in a permitted or licensed

facility.

Yellow and black Offensive/hygiene waste, e.g., feminine

hygiene waste, nappies from healthy

children, uncontaminated PPE,

uncontaminated dressings.

Offensive/hygiene waste may be land filled

in a permitted or licensed facility.

Black Domestic waste, which does not contain

infectious materials, sharps or medicinal

products, e.g., newspapers, paper towels

from hand washing, uncontaminated couch

roll, packaging from instruments.

Domestic waste may be land filled in a

permitted or licensed site.

Clear or opaque receptacles can also be

used for domestic waste.

Recycling options should be considered

where available.

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Preventing Infection Workbook and Guidance

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Remember

Changing of curtains and screens should documented.

Pillows should be encased in a cleanable plastic case.

Test your knowledge Please tick the correct answer True False

1. It is best practice to use disposable paper

products in General Practice.

2. Curtains and fabric screen should be

changed 3 monthly.

3. Uniforms should be washed at 30oC.

Note

Fabric hand towels should not be used in General Practice

by staff or patients as they can harbour micro-organisms

which can be transferred from one person to another.

It’s a fact

In the second half of the 19th century, commercial

laundries began using steam-powered mangles or ironers.

In 1920, the first commercially launderable permanent-

press fabrics were introduced.

In 1937 the first automatic electric washing machine was

invented.

To further reduce any micro-organisms, where possible,

uniforms or clothing should be tumble dried and/or ironed.

Always wash hands after placing uniforms or clothing in

the washing machine.

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Preventing Infection Workbook and Guidance

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) Chlorine-based disinfectants at 1,000 parts per million (ppm)

should be used for the disinfection of equipment that has

been in contact with an infected patient, non-intact skin, body

fluids (not blood) or mucous membranes, e.g., areas of the

body producing mucus, such as inside of the nose, mouth or

vagina.

Note: some chlorine-based disinfectants, e.g., Chlor-Clean,

Actichlor Plus, Tristel, contain both detergent and chlorine,

this reduces the need to clean equipment before disinfection.

Chlorine-based disinfectants

10,000 ppm available chlorine

When to use

10,000 ppm

On equipment that is contaminated with

blood or blood stained body fluids.

What to use Use Sodium Dichloroisocyanurate (NaDCC),

e.g., Haz-Tab, Actichlor, tablets as per

manufacturer’s instructions.

A diluter bottle should be used to ensure the

correct dilution is achieved.

Chlorine-based disinfectants

1,000 ppm available chlorine

When to use

1,000 ppm

On equipment that comes into contact with a

known or suspected infected patient, non-

intact skin, body fluids (not blood) or mucous

membranes.

What to use

Use Sodium Dichloroisocyanurate (NaDCC),

e.g., Haz-Tab, Actichlor, Chlor-Clean,

Actichlor Plus, tablets as per manufacturer’s

instructions.

A diluter bottle should be used to ensure the

correct dilution is achieved.

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11. Isolation Dedicated isolation treatment rooms are not required in

General Practices, but General Practices are expected to

implement reasonable precautions when a patient is

suspected or known to have a transmissible infection, Health

and Social Care Act 2008: Code of Practice on the prevention

and control of infections and related guidance.

The implementation of standard precautions will reduce the

risk of the transmission of infection in General Practice.

However, patients with specific infections who may be a risk

to others, e.g., a child with chickenpox or a patient with

influenza during an outbreak of Pandemic Influenza, should

be segregated so that the risk of infection to other patients in

waiting or communal areas is minimised. Where possible,

arrangements should be made to see these patients in their

own home or in a separate area of the practice away from

other patients.

Preparation

Refer to your local policy on Isolation.

The designated room or area should be free from clutter

and where possible, equipment not required for the

consultation should be removed from the room.

A risk assessment should be undertaken for the personal

protective equipment (PPE) required, e.g., disposable

apron and gloves. The routine wearing of masks is usually

not required, however for certain infections, e.g., Pandemic

Influenza, Ebola, or new emerging

infections, national guidance should

be followed.

PPE should be worn and removed

correctly (see page 19).

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Wear a disposable apron and sterile gloves.

Ensure all fluids, equipment and materials used are sterile.

Check sterile packs are within the expiry date and there is

no evidence of damage or moisture penetration.

Ensure contaminated or non-sterile items are not placed in

the sterile field.

Do not reuse single use items.

Aseptic technique competency

Only staff trained and competent in an

aseptic technique should undertake this procedure.

An ‘Aseptic technique competency assessment record’

and ‘Aseptic technique procedure audit tool’ for both

urinary catheterisation and wound dressing are available at

www.infectionpreventioncontrol.co.uk.

It is good practice to undertake peer audits to monitor

competency and a record of training and audit should be

available.

Procedure for dressing a wound using an aseptic technique

Explain the procedure to the patient.

Be ‘Bare Below the Elbows’. Decontaminate hands with

liquid soap and warm water and dry with paper towels or

use an alcohol handrub and allow to dry.

Decontaminate the dressing trolley with detergent and

warm water or detergent wipes.

Assemble dressing packs and equipment, check all items

are in date and packaging is intact.

Position patient comfortably and decontaminate hands.

Put on a disposable apron.

13

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Preventing Infection Workbook and Guidance

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Specimens delivered by patients

Wherever possible, reception staff should avoid handling

specimens due to the risk of infection.

Specimens should be in an appropriate container.

If there is leakage or an inappropriate container is used,

the specimen should be rejected as it may not be

processed by the laboratory due to the risk of infection.

In exceptional circumstances, if a specimen is not in an

appropriate container and where transfer to the correct

container is necessary, PPE should be worn.

Specimens should be labelled correctly and all details

completed on the form and placed in the appropriate

specimen bag.

14

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Specimen Indication Container

Wound

swab

Swelling, redness, heat, a

yellow or green discharge,

increased discharge of fluid,

wound deterioration, fever.

Sterile cotton swab in

transport medium.

Charcoal medium

increases survival of

bacteria during

transportation. Store at

room temperature.

Sputum Productive cough (green or

yellow) or presence of blood

in sputum.

Plain universal container.

Store at room

temperature.

Urine Pain on passing urine,

increase in frequency, fever,

new urinary incontinence,

new or worsening confusion,

flank or lower abdominal

pain.

Universal container with

boric acid (red top) which

prevents bacteria from

multiplying in the

container.

Refrigerate.

Faeces Diarrhoea, increase in

frequency, presence of

blood, abdominal pain.

Stool specimen container

(at least 1/4 full). Store at

room temperature.

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Preventing Infection Workbook and Guidance

52 15

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Viral gastroenteritis is spread by:

contaminated hands of patients and staff

contaminated surfaces and equipment

contaminated food (food can be contaminated when being

prepared by an infected person with viral gastroenteritis).

Advice for patients with viral gastroenteritis

Drink plenty of fluids to prevent dehydration.

Wash hands thoroughly after each episode of diarrhoea

and vomiting with liquid soap and warm water.

If possible, infected patients should try to avoid preparing

and handling food for other people until free from

symptoms for 48 hours.

Stay at home, do not visit friends, relatives, hospitals or

care homes, until free from symptoms for 48 hours.

Disinfect toilets and surrounding area at home with a

household bleach as per manufacturer’s instructions.

Cleaning an episode of diarrhoea or vomiting at the

General Practice

1. Wear appropriate personal protective equipment (PPE), e.g., disposable apron and gloves.

2. Ventilate the area if possible by opening windows and doors.

3. Clean up vomit or diarrhoea promptly with paper towels.

4. Use a spillage kit or clean area with detergent and warm water or detergent wipes followed by a chlorine-based disinfectant at 1,000 parts per million (see page 26).

5. Dispose of waste and PPE as infectious waste.

6. Wash hands with liquid soap and warm water.

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Preventing Infection Workbook and Guidance

56 16

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itant (n

on

-C.

difficile

) antib

iotics if safe

to

do s

o a

nd a

ny la

xatives. R

evie

w a

nd s

top a

ny c

oncom

itant P

PI use if possib

le. D

o n

ot

use a

ntim

otilit

y d

rugs,

e.g

., lo

pera

mid

e.

Pru

dent

antibio

tic p

rescrib

ing r

educes t

he r

isk o

f C

. difficile

in

fectio

n a

nd/o

r re

lapsin

g in

fectio

n. B

road

-spectr

um

agents

, in

part

icula

r,

should

not be p

rescrib

ed u

nle

ss there

is a

cle

ar

clin

ical need. F

or

patie

nts

with a

recent his

tory

, i.e., w

ithin

one y

ear,

of C

. difficile

, advic

e s

hould

be s

ought fr

om

a C

onsultant M

icro

bio

logis

t on a

ppro

pria

te a

ntib

iotic c

hoic

e f

or

recurr

ing C

DI.

F

aecal tr

anspla

natio

n is

undert

aken in

som

e h

ospitals

. F

urt

her

advic

e c

an b

e o

bta

ined fro

m y

our

local C

onsultant

Mic

robio

logis

t.

SAMPLE

Preventing Infection Workbook and Guidance

60

MRSA screening

In accordance with Department of Health guidance, MRSA

screening is routinely undertaken by hospitals. If a MRSA

positive result is diagnosed after a patient has been

discharged from hospital, the General Practice may be

contacted by the local Infection Prevention and Control (IPC)

or Public Health England (PHE) team to discuss the need for

decolonisation treatment.

If MRSA screening is to be undertaken at the General

Practice, swabs should be taken in accordance with local

policy. The sites to be swabbed usually include nose and any

vulnerable sites, e.g., wound, and if a urinary catheter is

in-situ a catheter specimen of urine should also be taken.

17

. M

RS

A

How to take a nasal swab for MRSA screening

Wash hands and apply non-sterile gloves.

Place a few drops of either sterile water or

sterile normal saline onto the swab taking

care not to contaminate the swab.

Place the tip of the swab inside the nostril at

the angle shown.

It is not necessary to insert the swab too far

into the nostril.

Gently rotate the swab ensuring it is touching

the inside of the nostril.

Repeat the process using the same swab for

the other nostril.

Place the swab into the container.

Dispose of gloves and wash hands.

Complete patient details on the container

and specimen form. Request ‘MRSA

screening’ under clinical details on the form.

SAMPLE

Preventing Infection Workbook and Guidance

66

It’s a fact

The toxin was first described by Panton and Valentine in 1932.

A PCR test for PVL virulence genes and simultaneous discrimination of MRSA from MSSA has recently been developed. The unit at Colindale can provide a result within the working day.

Use a clean designated towel which should be kept

separate, to avoid use by other people. The towel should

be washed frequently on a hot wash cycle, e.g., 60oC.

Regularly vacuum and dust with a damp cloth all rooms

including personal items. A household detergent is

adequate for cleaning.

Clean the wash basin, taps and bath after use with

household detergent and a disposable cloth.

Cover nose and mouth with a tissue when coughing or

sneezing, because PVL-SA can live in the nose.

Immediately dispose of the tissue and then wash hands

with liquid soap and warm water.

If you are a carer in a nursery, hospital, care home or work

in the food industry, e.g., chef, waitress, you should not

return to work until the lesion has healed.

Do not visit a gym or take part in contact sports until all

lesions are healed.

18

. P

VL

– S

tap

hy

loc

oc

cu

s a

ure

us

Test your knowledge Please tick the correct answer True False

1. PVL-SA can cause recurrent boils or skin

abscesses.

2. PVL-SA can be spread by using shared

towels and shared razors.

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72

It’s a fact

Identification of CPE in England by the Public Health England National Reference Laboratory has risen from fewer that 5 patients reported in 2006 to over 600 in 2013.

The resistant CPE bacteria produce an enzyme (carbapenemase) that breaks down the antibiotic and makes it ineffective.

Note

Patients found to be positive for

CPE either colonised or infected,

should have been given advice

about CPE and a CPE card. The

card should be shown to healthcare providers involved in

their care. For further details visit

www.infectionpreventioncontrol.co.uk

20

. C

PE

Remember

Using standard precautions will minimise the spread of

CPE and should be rigorously implemented, but no

additional infection control precautions are required.

Seek advice from your local Community Infection

Prevention and Control or Public Health England team if

required.

Test your knowledge Please tick the correct answer True False

1. There are very few antibiotics for the

treatment of CPE infections.

2. It is not necessary to undertake hand

hygiene when dealing with a CPE patient.

SAMPLE

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74

Key references British Medical Association (May 2012) CQC Registration—What you need to know, Appendix B

Policies and Protocols Guidance for GP Available at www.bma.org.uk. [Accessed 07/07/15]

Care Quality Commission Homepage [online] Available at www.cqc.org.uk. [Accessed 14/07/15]

Department of Health (July 2015) The Health and Social Care Act 2008: Code of Practice on the

prevention and control of infections and related guidance

Department of Health (June 2015) Toolkit for managing carbapenemase-producing

Enterobacteriaceae in non-acute and community settings

Department of Health (2013) Health Technical Memorandum 07-01: Safe management of

healthcare waste

Department of Health (January 2009) Clostridium difficile infection: How to deal with the problem

Harrogate and District NHS Foundation Trust (May 2015) Community Infection Prevention and

Control Guidance for Health and Social Care

Health Protection Agency (November 2011) Guidelines for the management of Norovirus

outbreaks in acute and community health and social care settings

Health Protection Agency (November 2008) Guidance on the diagnosis and management of PVL-

associated Staphylococcus aureus infection (PVL-SA) in England 2nd Edition

Healthcare Commission (October 2007) Investigation into outbreaks of Clostridium difficile at

Maidstone and Tunbridge Wells NHS Trust

Loveday HP, et al, epic3: National Evidence-Based Guidelines for Preventing Healthcare-Associated Infections in NHS Hospitals in England Journal of Hospital Infection 86S1 (2014) S1–S70

Medicines and Healthcare Products Regulatory Agency (April 2015) Managing Medical Devices

Guidance for healthcare and social services organisations Available at www.gov.uk/government/

publications/managing-medical-devices. [Accessed 22/07/15]

Mid Staffordshire NHS Foundation Trust (2013) The Report of the Mid Staffordshire NHS

Foundation Trust Public Inquiry volume 2: Analysis of evidence and lessons learned (part 2),

Chaired by Robert Francis QC 2013

National Institute for Health and Care Excellence (August 2015) Antimicrobial stewardship:

systems and processes for effective antimicrobial medicine use Available at www.nice.org.uk/

guidance/ng15/resources. [Accessed 19/08/15]

National Institute for Health and Clinical Excellence (2012) Infection: prevention and control of

healthcare-associated infections in primary and community care Clinical Guideline 139

National Patient Safety Agency (August 2010) The national specifications for cleanliness in the

NHS: Guidance on setting and measuring performance outcomes in primary care medical and

dental premises

Public Health England (2013) Immunisation Against Infectious Disease (The Green Book) Available at www.gov.uk/government/collections/immunisation-against-infectious-disease-the-green-book. [Accessed 06/07/15]

Royal College of Nursing (April 2014) The Management of waste from health, social and personal

care RCN guidance

Royal College of Nursing (January 2012) Essential practice for infection prevention and control

Royal College of Nursing (2012) Tools of the trade: RCN guidance for health care staff on glove

use and the prevention of contact dermatitis

Royal Marsden (March 2015) The Royal Marsden Hospital Manual of Clinical Nursing Procedure

9th Edition [online] Available at www.rmmonline.co.uk. [Accessed 14/07/15]

Ke

y r

efe

ren

ce

s

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76

Written and produced by Community Infection Prevention and Control

Harrogate and District NHS Foundation Trust

Tel: 01423 557340

www.infectionpreventioncontrol.co.uk

August 2015

© Harrogate and District NHS Foundation Trust, Community Infection Prevention and Control 2015

SAMPLE