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The Health and Social Care Act 2008

Code of Practice on the prevention and control of infections and related guidance

DH INFORMATION READER BOX

Policy Estates HR/Workforce Commissioning Management IM&T Planning Finance Clinical SocialCare/PartnershipWorking

Document purpose Policy

Gateway reference 14808

Title TheHealthandSocialCareAct2008Codeof Practiceonthepreventionand controlof infectionsandrelatedguidance

Author Departmentof Health

Publication date December2010

Target audience PCTCEs,NHSTrustCEs,SHACEs,CareTrustCEs,FoundationTrustCEs, MedicalDirectors,Directorsof PH,Directorsof Nursing,LocalAuthority CEs,Directorsof AdultSSs,PCTChairs,NHSTrustBoardChairs,Allied HealthProfessionals,GPs,Primarycareorganisations,dentists,independent ambulances,independenthealthcareandadultsocialcareorganisations, directorsof infectionpreventionandcontrol,infectionpreventionandcontrol leads,CareQualityCommission

Circulation list

Description Tohelpprovidersof healthcare,includingprimar ydentalcare,primarymedical care,adultsocialcare,andindependentsectorambulanceproviders,plan andimplementhowtheypreventandcontrolinfections.Itincludescriteriafor CQCtotakeintoaccountwhenassessingcompliancewiththeregistration requirementoncleanlinessandinfectioncontrol.

Cross reference N/A

Superseded docs TheHealthandSocialCareAct2008Codeof Practiceforhealthandadult socialcareonthepreventionandcontrolof infectionsandrelatedguidance.

Action required RegisteredprovidersmusthaveregardtotheCodewhendecidinghowthey willcomplywithregistrationrequirementforcleanlinessandinfectioncontrol.

Timing Primary dental care and independent sector ambulance providers must be registered by April 2011, and primary medical care providers by April 2012. The Code already applies to other registered providers.

Contact details SallyWellsteed HealthcareAssociatedInfectionandAntimicrobialResistance Room528,WellingtonHouse 133-155WaterlooRoad LondonSE18UG [email protected]

For recipient’s use

©Crowncopyright2010 FirstpublishedDecember2010 PublishedtoDHwebsite,inelectronicPDFformatonly.

http://www.dh.gov.uk/publications

mailto:[email protected]://www.dh.gov.uk/publications

The Health and Social Care Act 2008

Code of Practice on the prevention and control of infections and related guidance

iii

Contents�

Executive summary 5�

Part 1: Introduction 7� WhatandwhoistheCodeof Practicefor? 7

Thetermsusedinthisdocument 8

Background 9

Whatischanging? 9

Whenwillthishappen? 9

HowwilltheCodebeused? 10

Howwillcompliancebejudged? 10

Whathappensif aregisteredproviderdoesnotmeettherequirements

intheCode? 11

Commissioningof services 11

Keycomponentstosupportcompliance 12

Part 2: The Code of Practice 13�

Part 3: Guidance for compliance 14�

Part 4: Guidance tables 38�

Appendix A:Examplesof interpretationforadultsocialcare 46

Appendix B:Examplesof interpretationforprimarydentalcare 56

Appendix C:Examplesof interpretationforindependentsector

ambulanceproviders 64

Appendix D:Examplesof interpretationforprimarymedicalcare 70

Appendix E:Definitions 78

Appendix F:Regulations(extract) 86

Bibliography 87�

iv

Executive summary�

Goodinfectionpreventionandcontrolareessentialtoensurethatpeoplewho usehealthandsocialcareservicesreceivesafeandeffectivecare.Effective preventionandcontrolof infectionmustbepartof everydaypracticeandbe appliedconsistentlybyeveryone.

Goodmanagementandorganisationalprocessesarecrucialtomakesurethat highstandardsof infectionpreventionandcontrolaredevelopedandmaintained.

ThisdocumentsetsouttheCodeof Practiceonthepreventionandcontrol of infections,underTheHealthandSocialCareAct2008.Itwillapplyto registeredprovidersof allhealthcareandadultsocialcareinEngland.The Codeof Practice(Part2)setsoutthe10criteriaagainstwhichtheCare QualityCommission(CQC)willjudgearegisteredprovideronhowitcomplies withthecleanlinessandinfectioncontrolrequirement,whichissetoutin regulations.1Notallcriteriawillapplytoeveryregulatedactivitybuttoensure thatconsistentlyhighlevelsof infectionpreventionandcontrolaredeveloped andmaintained,itisessentialthatallprovidersof healthandsocialcareread andconsiderthewholedocumentandnotjustselectiveparts.

Parts3and4of thisdocumentwillhelpregisteredprovidersinterpretthecriteria anddeveloptheirownriskassessments.Theappendicesprovideexamples of howaproportionateapproachcouldbeappliedtothecriteriainallsectors anditisimportanttoreadtheexamplesgivenintheappendices,alongsidethe guidanceundereachcriterioninPart3of thisdocument.Thebibliographylists arangeof supportingnationalguidance.

ThisdocumentbuildsonthepreviousCodeof Practice:The Health and Social Care Act 2008 Code of Practice for health and adult social care on the prevention and control of infections and related guidance,whichappliedtoNHS bodiesandprovidersof independenthealthcareandadultsocialcareinEngland.

TheregistrationrequirementswillextendfurtherfromApril2011toinclude primarydentalcareandindependentsectorambulanceproviders,including airorwaterambulances,andfromApril2012primarymedicalcareproviders. WehaverevisedthepreviousCodeof Practicedocumentinordertomakeit applicabletoallthesesettings.

1 TheHealthandSocialCareAct2008(RegulatedActivities)Regulations2010.Availableat: www.legislation.gov.uk/search?title=The+Health+and+Social+Care+Act+2008+%28Regulated +Activities%29+Regulations+2010&year=&number=&type=uksi

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TheHealthandSocialCareAct2008CodeofPracticeonthepreventionandcontrolofinfections

ThelawstatesthattheCodemustbetakenintoaccountbytheCQCwhenit makesdecisionsaboutregistrationagainstthecleanlinessandinfectioncontrol requirement.Theregulationsalsosaythatprovidersmusthaveregardtothe Codewhendecidinghowtheywillcomplywithregistrationrequirements.So,by followingtheCode,registeredproviderswillbeabletoshowthattheymeetthe requirementsetoutintheregulations.However,theCodeisnotmandatoryso registeredprovidersdonotbylawhavetocomplywiththeCode.Aregistered providermaybeabletodemonstratethatitmeetstheregulationsinadifferent way(equivalentorbetter)fromthatdescribedinthisdocument.TheCodeaims toexemplifywhatprovidersneedtodoinordertocomplywiththeregulations.

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Part 1: Introduction

Goodinfectionpreventionandcontrolareessentialtoensurethatpeoplewho usehealthandsocialcareservicesreceivesafeandeffectivecare.Effective preventionandcontrolof infectionmustbepartof everydaypracticeandbe appliedconsistentlybyeveryone.

Goodmanagementandorganisationalprocessesarecrucialtomakesurethat highstandardsof infectionpreventionandcontrolaresetupandmaintained.

Astheregulatorof healthandadultsocialcareinEngland,theCareQuality Commission(CQC)willprovideassurancethatthecarepeoplereceive,meets essentiallevelsof qualityandsafety.Thesearesetoutinregulations.2This documentoutlineswhatregisteredprovidersinEngland,shoulddotoensure compliancewiththeregistrationrequirementforcleanlinessandinfectioncontrol andsetsoutthe10compliancecriteriaagainstwhichregisteredproviderswill bejudged.

TheCQChavepublishedguidanceaboutcompliance,includingtheirjudgement framework3andwillusethesedocumentsinconjunctionwiththisCodeof Practiceandrelatedguidancewhenjudgingcompliance.

What and who is the Code of Practice for?

Themainpurposesof theCodeof Practiceonthepreventionandcontrolof infections(TheCode)areto:

• maketheregistrationrequirementforcleanlinessandinfectioncontrolclear toallregisteredproviderssothattheyunderstandwhattheyneedtodo tocomply;

• provideguidancefortheCQC’sstaff tomakejudgementaboutcompliance withtherequirementforcleanlinessandinfectioncontrol;

• provideinformationforpeoplewhousetheservicesof aregisteredprovider;

2 www.legislation.gov.uk/search?title=The+Health+and+Social+Care+Act+2008+%28Regulated +Activities%29+Regulations+2010&year=&number=&type=uksi

3 SeeGuidance about compliance: Essential standards of quality and safetyat:www.cqc.org. uk/_db/_documents/Essential_standards_of_quality_and_safety_March_2010_FINAL.pdfand Guidance about compliance Judgement frameworkat:www.cqc.org.uk/_db/_documents/ Judgement_framework_March_2010_FINAL.pdf

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http://www.legislation.gov.uk/search?title=The+Health+and+Social+Care+Act+2008+%28Regulated+Activities%29+Regulations+2010&year=&number=&type=uksihttp://www.cqc.org.uk/_db/_documents/Essential_standards_of_quality_and_safety_March_2010_FINAL.pdfhttp://www.cqc.org.uk/_db/_documents/Judgement_framework_March_2010_FINAL.pdf


• provideinformationforcommissionersof servicesonwhattheyshould expectof theirproviders;and

• provideinformationforthegeneralpublic.

ReaderswillnotethatonlyparagraphsinPart3of thisdocumenthavebeen numbered,astheseparticularsectionsarelikelytobespecificallyreferencedby theCQCinensuringcompliancewiththeregulations.

The terms used in this document

Thereareawiderangeof termsrelatingtoservices,organisationalstructures anddifferentwaystodescribethesameorsimilarthingsacrosshealthand socialcare.Inthisdocumentwehavetriedtoharmonisesomeof thoseterms andusedescriptionsthataremeaningfulacrossallsectors.

Forexample,wehaveusedtheterm‘serviceuser’todescribepatients,donors, residentsandclients.BecauseNationalHealthService(NHS)Trusts(asan entity),primarycare,independenthealthcare,independentsectorambulance providers,andadultsocialcareprovidersareallrequiredtoregisterwiththe CQCasprovidersof healthoradultsocialcare,theyarereferredtointhis documentas‘registeredproviders’.Theterm‘careworker’isusedtoreferto anyemployeewhosenormaldutiesinvolveprovidingdirectcaretoservice users,forexamplemedicalstaff,nurses,healthcareassistants,careassistants andvolunteers.Theterm’independentsectorambulanceproviders‘includes triage,medicalorclinicaladviceprovidedremotely,face-to-facetreatmentand transportservices.Transportservicesarethoseprovidedbymeansof vehicles, whicharedesignedfortheprimarypurposeof carryingapersonwhorequires treatment.Theterm’vehicle‘includesroad,airorwaterambulances.

However,therearesomecircumstanceswhereusingaterm,whichhasa specificmeaningineitherhealthcare,includingprimarycareand,independent sectorambulanceprovidersoradultsocialcarehasbeenthebestwayto describewhatneedstobedonetocomplywiththeregulationsbyhavingregard totheCodeandtherelatedguidance.

Theterm‘infection’isusedthroughoutthisdocument,ratherthanthemore explicitterm‘healthcareassociatedinfection’,exceptforcircumstanceswhere thespecifictermisappropriate.TheCoderecognisesthatsomeinfectionsthat ariseinthecommunitysuchasinfluenzaareresponsibleformuchmorbidity inresidentialunitsandmaynotberelatedtothedeliveryof healthcare. Nevertheless,theymaybepreventablebygoodpractice,suchasimmunisation, whichisdealtwithintheCodeandtherelatedguidance.AppendixEprovides furtherdefinitions.

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Part1:Introduction

Background

ThisdocumentbuildsonthepreviousCodeof PracticeThe Health and Social Care Act 2008 Code of Practice for health and adult social care on the prevention and control of infections and related guidance.ThepreviousCodeof Practice appliedtoNHSbodiesandprovidersof independenthealthcareandadultsocial careinEngland,andwasusedbytheCQCtojudgewhetherthoseproviders compliedwiththeregistrationrequirementforcleanlinessandinfectioncontrol.

Althoughtherelatedguidancehasbeenupdated,therevisedguidancedoesnot introduceanynewrequirements.

What is changing?

Thewaythathealthandadultsocialcareisregulatedhasbeenchanging sinceApril2009becauseof theintroductionof theHealthandSocialCare Act2008(H&SCA2008).4ThisActestablishedtheCQCandsetsoutthe overallframeworkfortheregulationof healthandadultsocialcareactivities. RegulationsmadeunderthisActdescribethehealthandadultsocialcare activities,thatmayonlybecarriedoutbyprovidersthatareregisteredwith theCQC,andsetouttheregistrationrequirementsthattheseproviders mustmeettobecomeandstayregistered.FurtherdetailsonhowtheCQC willassesscompliancewiththeregistrationrequirementsareavailableat: www.cqc.org.uk/guidanceforprofessionals/registration/newregistrationsystem/ howthenewregistrationsystemwork/complyingwithnewregulations.cfm

TheH&SCA2008andregulationsarelawandmustbecompliedwith.TheCQC hasenforcementpowersthatitmayuseif registeredprovidersdonotcomply withthelaw.

When will this happen?

NHSbodiesprovidingregulatedactivities,includingprisonhealthcareservices, havebeenrequiredtocomplywiththefullsetof registrationrequirementssince 1April2010withindependenthealthcareandadultsocialcareprovidersof regulatedactivitiesrequiredtocomplywiththemfrom1October2010.Primary dentalcareandindependentsectorambulanceprovidersmustberegisteredby April2011,andprimarymedicalcareprovidersbyApril2012.

4 TheHealthandSocialCareAct2008isavailableat:www.legislation.gov.uk/search?title=heal th+and+social+care+act&yearRadio=range&start-year=2008&end-year=2009&number=&serie s=&type=primary

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www.cqc.org.uk/guidanceforprofessionals/registration/newregistrationsystem/howthenewregistrationsystemwork/complyingwithnewregulations.cfmhttp://www.legislation.gov.uk/search?title=health+and+social+care+act&yearRadio=range&start-year=2008&end-year=2009&number=&series=&type=primary


TheregulatedactivitiesandregistrationrequirementsaresetoutintheHealth andSocialCareAct2008(RegulatedActivities)Regulations2010.Thisis availableat:

www.legislation.gov.uk/search?title=The+Health+and+Social+Care+Act+2008+% 28Regulated+Activities%29+Regulations+2010&year=&number=&type=uksi

How will the Code be used?

Section21of theH&SCA2008enablestheSecretaryof StateforHealthto issueaCodeof Practiceabouthealthcareassociatedinfections.TheCode containsstatutoryguidanceaboutcompliance5withtheregistrationrequirement forcleanlinessandinfectioncontrol(regulation12of theHealthandSocialCare Act2008(RegulatedActivities)Regulations2010).

ThelawstatesthattheCodemustbetakenintoaccountbytheCQCwhenit makesdecisionsaboutregistrationagainstthecleanlinessandinfectioncontrol requirement.Theregulationsalsosaythatprovidersmusthaveregardtothe Codewhendecidinghowtheywillcomplywithregistrationrequirements.So, byfollowingtheCode,registeredproviderswillbeabletoshowthattheymeet theregulationoncleanlinessandinfectioncontrol.However,theydonotbylaw havetocomplywiththeCode.Aregisteredprovidermaybeabletodemonstrate thatitmeetstheregistrationrequirementregulationoncleanlinessandinfection controlinadifferentway(equivalentorbetter)fromthatdescribedinthisdocument.

Tobecomeandstayregistered,providersmustmeetthefullrangeof registrationrequirements.TheCQChaspublishedguidanceabouthowto complywithalltherequirementsotherthantheoneoncleanlinessandinfection control.ThisguidanceisinGuidance about compliance: Essential standards of quality and safety,whichcanbefoundat: www.cqc.org.uk/_db/_documents/Essential_standards_of_quality_and_safety_ March_2010_FINAL.pdf

TheCodedoesnotreplacetherequirementtocomplywithanyotherlegislation thatappliestohealthandadultsocialcareservices,forexample,theHealth andSafetyatWorketc.Act1974andtheControlof SubstancesHazardousto HealthRegulations2002.

How will compliance be judged?

TheCQCisresponsibleforjudgingcompliancewiththeregistration requirementssetoutinregulations.Whendoingthisforthecleanlinessand

5 TheCQChaspublishedguidanceaboutcompliancewiththeremainingregistration requirements.Furtherdetailsareavailableatwww.cqcguidanceaboutcompliance.org.uk/

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http://www.legislation.gov.uk/search?title=The+Health+and+Social+Care+Act+2008+%28Regulated+Activities%29+Regulations+2010&year=&number=&type=uksihttp://www.cqc.org.uk/_db/_documents/Essential_standards_of_quality_and_safety_March_2010_FINAL.pdfhttp://www.cqcguidanceaboutcompliance.org.uk/

Part1:Introduction

infectioncontrolrequirement,itwilltakeaccountof theCodeandhow registeredprovidersaredoingwhattheCodesays.Itwilldothisinawaythat isproportionatetotheriskof infection.

Allregisteredproviderswillneedtohaveadequatesystemsforinfection preventionandcontrol,asstatedintheCode(seePart2),if theyareto complywiththelaw,butbecauseof thewiderangeof servicesprovidedby allregisteredproviders,theCodewillbeappliedinaproportionateway.For example,inanacutehospitalsettingthereisagreaterrisktopatientsof infectionandthereforetheregisteredproviderwillneedtocomplywithmost aspectsof thecompliancecriteria.However,inaserviceprovidedinsomeone’s ownhomeoracarehomewherepeoplearesupportedtobeindependentina domesticsetting,theregisteredproviderwillnotneedtohavethesamefacilities andapproachasanacutehospital.

What happens if a registered provider does not meet the requirements in the Code?

TheCQCmayuseitsenforcementpowersortakeotheractionwhereitdecides thataregisteredproviderisnotmeetingitslegalobligationsassetoutinthe regulations.Itwillreachthisdecisionbylookingatwhetheraregisteredprovider isdoingwhatissetoutintheCode.If aregisteredproviderisnotfollowing theCode,thentheCQCwillwanttoconsiderwhetherthatisbecauseitisnot appropriatetothetypeof servicebeingprovided.If itisappropriate,theCQC willwanttoconsiderwhetheraregisteredproviderisstillprotectingpeoplefrom theriskof infectioninanother,equallyeffectiveway.

FurtherinformationabouthowtheCQCwillassessregisteredproviders andwhatactionitcantakeif aregisteredproviderdoesnotcomplywiththe regulationcanbefoundonitswebsite (www.cqc.org.uk/guidanceforprofessionals/registration/newregistrationsystem/ howthenewregistrationsystemwork/complyingwithnewregulations.cfm)orby contactingitscustomerservicesteamon03000616161.

Commissioning of services

TheCQCisresponsibleformonitoringcompliancewiththerequirementsof theHealthandSocialCareAct2008(RegulatedActivities)Regulations2010. Commissioningorganisationsmaywishtoassurethemselvesthattheservices thattheycommissionaremeetingexpectedrequirementsandthismayinvolve contractmonitoringof theservice.Indoingso,commissionersmustmakeit cleartotheproviderthatthisdoesnotreplaceorduplicatetheregulatoryrole of theCQC.

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Key components to support compliance

Thisdocumentprovidesarangeof informationincludingappendices,tables, definitionsandanextensivebibliographytosupportprovidersincomplyingwith theregulations.

Part2(TheCode)detailsthecriteriaagainstwhichtheregisteredproviderwill bejudgedonhowitcomplieswiththeregistrationrequirementforcleanliness andinfectioncontrol.Part3(Guidanceforcompliance)providesguidanceon howtointerpretthecompliancecriteriaanddevelopriskassessments.Part4 (Guidancetables)detailstherelevantcriteriathatmightapplytoeachregulated activity,offerspotentialsourcesof professionalinfectionpreventionandcontrol adviceand,listswhichpoliciesmayberequiredtodemonstratecompliance withcriterion9.

Theappendicesprovideexamplesof howaproportionateapproachcouldbe appliedtothecriteriainadultsocialcare,primarydentalcare,independent sectorambulanceproviders,andprimarymedicalcareservices.However,itis importanttoreadtheexamplesgivenintheappendices,alongsidetheguidance undereachcriterioninPart3of thisdocumentandnotjustselectiveparts.

Thebibliographylistsarangeof supportingnationalguidance.Although mostof theseguidancedocumentswerewrittenfortheNHSandpriorto theestablishmentof theCQCanditsregistrationrequirements,therewillbe elementsthatarerelevanttootherregisteredproviders.Howtheyareusedisa matterforlocaldetermination.

Usersmayfindthewebsiteof theNationalResourceforInfectionControl (www.nric.org.uk)ausefulsiteforaccessingthesedocumentsandother relevantmaterial.

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Part 2: The Code of Practice�

Thetablebelowisthe‘Codeof Practice’forallprovidersof healthcare andadultsocialcareonthepreventionandcontrolof infectionsunderThe HealthandSocialCareAct2008.Thissetsoutthe10criteriaagainstwhich aregisteredproviderwillbejudgedonhowitcomplieswiththeregistration requirementforcleanlinessandinfectioncontrol.Notallcriteriawillapplyto everyregulatedactivity.Parts3and4of thisdocumentwillhelpregistered providersinterpretthecriteriaanddeveloptheirownriskassessments.

Compliance criterion

What the registered provider will need to demonstrate

1 Systemstomanageandmonitorthepreventionandcontrolof infection.Thesesystemsuseriskassessments andconsider howsusceptibleserviceusersareandanyrisksthattheir environmentandotherusersmayposetothem.

2 Provideandmaintainacleanandappropriateenvironmentin managedpremisesthatfacilitatesthepreventionandcontrol of infections.

3 Providesuitableaccurateinformationoninfectionstoservice usersandtheirvisitors.

4 Providesuitableaccurateinformationoninfectionstoany personconcernedwithprovidingfurthersuppor tornursing/ medicalcareinatimelyfashion.

5 Ensurethatpeoplewhohaveordevelopaninfectionare identified promptlyandreceivetheappropriatetreatment andcaretoreducetheriskof passingontheinfectionto otherpeople.

6 Ensurethatallstaff andthoseemployedtoprovidecarein allsettingsarefullyinvolvedintheprocessof preventingand controllinginfection.

7 Provideorsecureadequateisolationfacilities.

8 Secureadequateaccesstolaboratorysuppor tasappropriate.

9 Haveandadheretopolicies,designedfortheindividual’s careandproviderorganisations,thatwillhelptopreventand controlinfections.

10 Ensure,sofarasisreasonablypracticable,thatcareworkers arefreeof andareprotectedfromexposuretoinfectionsthat canbecaughtatworkandthatallstaff aresuitablyeducated inthepreventionandcontrolof infectionassociatedwiththe provisionof healthandsocialcare. 13


Part 3: Guidance for compliance Inordertoachievecompliancewiththeregistrationrequirementsrelatingto infectionpreventionandcontrol,registeredproviderswouldnormallybeexpected todemonstratethattheyhaveinplacethepoliciesandprocedurestomeet eachrelevantcriterionlistedinPart2andhavetakenaccountof thefollowing guidanceforcompliance.Thisguidanceisnotmandatorybutisconsideredto representthebasicstepsthatarerequiredtoensurethatthecriteriacanbemet.

Theremaybeadditionaloralternativestrategiesthataregisteredprovider isabletojustifyasequivalent,ormoreeffective,inachievingcompliancein theircircumstances.Registeredprovidersarefreetodecidetousealternative approachesbutshouldbepreparedtojustifytotheCQChowthechosen approachisequallyeffectiveorbetterinensuringthatthecriteriaaremet. Providersof regulatedactivitiesneedtorecognisethateffectivemanagementof infectionpreventionandcontrolisanimportantserviceusersafetyissue.

ThetablesinPart4maybeusedasaguidetohelptodecideontheapplication of theindividualcompliancecriteriaandavailableinfectionpreventionand controladvice.Theprincipleof propor tionalityextendsthroughoutthisguidance and,whereitisdecidedapolicyshouldexist,thepolicy’slevelof detailand complexitywilldependonlocalneedbasedonriskassessment.

Guidance for compliance with criterion 1

Systemstomanageandmonitorthepreventionandcontrolof infection.These systemsuseriskassessments andconsiderhowsusceptibleserviceusers areandanyrisksthattheirenvironmentandotherusersmayposetothem.

1.1 Appropriatemanagementandmonitoringarrangementsshouldensurethat:

• aregisteredproviderhasanagreementwithintheorganisationthat outlinesitscollectiveresponsibilityforkeepingtoaminimumtherisks of infectionandthegeneralmeansbywhichitwillpreventandcontrol suchrisks;

• anindividualisdesignatedastheleadforinfectionpreventionand controlandbeaccountabledirectlytotheregisteredprovider;

• themechanismsareinplacebywhichtheregisteredprovider intendstoensurethatsufficientresourcesareavailabletosecurethe effectivepreventionandcontrolof infection.Theseshouldincludethe

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Part3:Guidanceforcompliance

implementationof aninfectionpreventionandcontrolprogramme,

infectionpreventionandcontrolinfrastructureandtheabilitytodetect

andreportinfections;

• relevantstaff,contractorsandotherpersons,whosenormaldutiesare

directlyorindirectlyconcernedwithprovidingcare,receivesuitableand

sufficientinformationon,andtrainingandsupervisionin,themeasures

requiredtopreventandcontroltherisksof infection;

• aprogrammeof auditisinplacetoensurethatkeypoliciesand

practicesarebeingimplementedappropriately;

• apolicyoninformationsharingwhenreferring,admitting,transferring,

dischargingandmovingserviceuserswithinandbetweenhealthand

adultsocialcarefacilitiesisavailable;and

• adecontaminationleadisdesignated,whereappropriate.

(Refer also to Outcome 6, Regulation 24 Cooperating with other providers contained in CQC Guidance about compliance)

Risk assessment

1.2 Aregisteredprovidershouldensurethatithas:

• madeasuitableandsufficientassessmentof theriskstotheperson

receivingcarewithrespecttopreventionandcontrolof infection;

• identifiedthestepsthatneedtobetakentoreduceorcontrolthoserisks;

• recordeditsfindingsinrelationtothefirsttwopoints;

• implementedthestepsidentified;and

• putappropriatemethodsinplacetomonitortherisksof infectionto

determinewhetherfurtherstepsareneededtoreduceorcontrolinfection.

Directors of Infection Prevention and Control (in NHS provider organisations)

1.3 Theroleof theDIPC6inNHSproviderorganisationsisto:

• beaccountabledirectlytothechief executiveandtotheboard(butnot

necessarilyamemberof theboard);

• beresponsiblefortheorganisation’sinfectionpreventionandcontrol

team(IPT)orinfectioncontrolteam(ICT)7;

6 ThisrolewasfirstdescribedinWinning ways: working together to reduce healthcare associated infection in EnglandandhasbeendescribedinpreviouseditionsoftheCode.

7 HereafterbothIPTandICTarereferredtoasICTinthisdocument.

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• overseelocalpreventionandcontrolof infectionpoliciesandtheir implementation;

• beafullmemberof theICTandregularlyattenditsinfectionprevention andcontrolmeetings;

• reportdirectlytotheNHSboardand,innon-NHScaresettings,the registeredprovider;

• havetheauthoritytochallengeinappropriatepracticeandinappropriate antibioticprescribingdecisions;

• assesstheimpactof allexistingandnewpoliciesoninfectionsand makerecommendationsforchange;

• beanintegralmemberof theorganisation’sclinicalgovernanceand patientsafetyteamsandstructures;and

• produceanannualreportandreleaseitpubliclyasoutlinedinWinning ways: working together to reduce healthcare associated infection in England.Suggestionsastowhatcouldbeincludedinthereportare providedinthetemplateat: www.dh.gov.uk/en/Publicationsandstatistics/Lettersandcirculars/ Dearcolleagueletters/DH_4083982

Infection Prevention and Control Lead (for example adult social care, primary dental and medical care and independent sector ambulance providers)

1.4 Theroleof theInfectionPreventionandControl(IPC)Leadinadultsocial care,primarydentalcare,primarymedicalcareandindependentsector ambulanceproviderswilldependontheorganisationalstructuresandon thelevelandcomplexityof thecareprovided.(Thisisadescriptionof how theroleof theDIPCinhealthcaremightbeappliedinthesesettings.)Their roleisto:

• beresponsiblefortheorganisation’sinfectionpreventionandcontrol managementandstructure;

• overseelocalpreventionandcontrolof infectionpoliciesandtheir implementation;

• reportdirectlytotheregisteredprovider;

• havetheauthoritytochallengeinappropriatepractice;

• assesstheimpactof allexistingandnewpoliciesoninfectionsand makerecommendationsforchange;

• beanintegralmemberof theorganisation’sgovernanceandservice usersafetyteamsandstructureswheretheyexist;and

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• produceanannualstatementwithregardtocompliancewithgood

practiceoninfectionpreventionandcontrolandmakeitavailable

onrequest.

Assurance framework

1.5 Activitiestodemonstratethatinfectionpreventionandcontrolarean integralpartof qualityassuranceshouldinclude:

In NHS provider organisations

• regularpresentationsfromtheDIPCand/ortheICTtotheNHSboardor

registeredprovider.Theseshouldincludeatrendanalysisforinfections

andcompliancewithauditprogrammes;

• quarterlyreportingtotheNHSboardorregisteredproviderbyclinical

directorsandmatrons(includingnurseswhodonotholdthespecifictitle

of ‘matron’butwhooperateatasimilarlevelof seniorityandwhohave

controloversimilaraspectsof thepatientorthepatient’senvironment).

Whatisreportedonwillvaryaccordingtothelocalarrangements.

Forexampleitmayinclude:

– monthlycleanlinessscores(unlessthisisdoneviatheestates andfacilitiesteam);

– monthlyPatientEnvironmentActionTeamscores(wherethisis agreedpractice);and

– contractperformancemeasureswhereprovisionisoutsourced, whichwillincludecleanliness measuresandissuesof non-complianceandsubsequentrectificationperformance;

• areviewof statisticsonincidenceof alertorganisms(forexample,but

notlimitedto,meticillin-resistantStaphylococcus aureus(MRSA)and

Clostridium difficile)andconditions,outbreaksandseriousuntoward

incidents;

• evidenceof appropriateactiontakentodealwithoccurrencesof

infectionincluding,whereapplicable,rootcauseanalysis;and

• anauditprogrammetoensurethatpolicieshavebeenimplemented;

In adult social care, primary dental care and primary medical care etc.

• evidenceofappropriateactiontakentodealwithoccurrencesofinfection;

• anauditprogrammetoensurethatappropriatepolicieshavebeen

developedandimplemented;and

• evidencethattheannualstatementfromtheIPCLeadhasbeen

reviewedand,whereindicated,actedupon.

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1.6 Inaccordancewithhealthandsafetyrequirements,wheresuitableand sufficientassessmentof risksrequiresactiontobetaken,evidencemust beavailableoncompliancewiththeregulationsor,whereappropriate, justificationof asuitablebetteralternative.Thisappliestoallhealthcare andadultsocialcare.

Infection prevention and control programme

1.7 Theinfectionpreventionandcontrolprogrammeshould:

• setobjectivesthatmeettheneedsof theorganisationandensurethe safetyof serviceusers;

• identifyprioritiesforaction;

• provideevidencethatrelevantpolicieshavebeenimplementedto reduceinfections;and

• if appropriate,reportprogressagainsttheobjectivesof theprogramme intheDIPC’sannualreportortheIPCLead’sannualstatement.

Infection prevention and control infrastructure

1.8 Aninfectionpreventionandcontrolinfrastructureshouldencompass:

• inacutehealthcaresettings,forexample,anICTconsistingof an appropriatemixof bothnursingandconsultantmedicalexpertise(with specialisttrainingininfectionpreventionandcontrol)andappropriate administrativeandanalyticalsupport,includingadequateinformation technology–theDIPCisakeymemberof theICT;

• inothersettings,therewillbeaninfectioncontrolnurse(ICN)oranother designatedpersonwhoisresponsibleforinfectionpreventionandcontrol mattersandhasaccesstospecialistexpertiseasnecessary;and

• 24-houraccesstoanominatedqualifiedinfectioncontroldoctor(ICD) orconsultantinhealthprotection/communicablediseasecontrol. Theregisteredprovidershouldknowhowtoaccessthisadvice.

Movement of service users

1.9 Thereshouldbeevidenceof jointworkingbetweenstaff involvedinthe provisionof advicerelatingtothepreventionandcontrolof infection;those managingbedallocation;carestaff anddomesticstaff inplanningservice userreferrals,admissions,transfers,dischargesandmovementsbetween departments;andwithinandbetweenhealthandadultsocialcarefacilities. Wherenecessary,ambulanceproviders,hospitalsandprimarycaretrusts (PCTs)mayneedtobeinvolvedinsuchplanning.

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1.10Aregisteredprovidermustensurethatitprovidessuitableandsufficient informationonaserviceuser’sinfectionstatuswheneveritarrangesfor thatpersontobemovedfromthecareof oneorganisationtoanother, orfromaserviceuser’shome,sothatanyriskstotheserviceuserand othersfrominfectionmaybeminimised.If appropriate,providersof a serviceuser’stransportshouldbeinformedof anyinfection.



Provideandmaintainacleanandappropriateenvironmentinmanaged premisesthatfacilitatesthepreventionandcontrolof infections.

(Refer also to Outcome 10, Regulation 15 Safety and suitability of premises contained in CQC Guidance about compliance)

2.1 Withaviewtominimisingtheriskof infection,aregisteredprovidershould normallyensurethat:

• itdesignatesleadsforenvironmentalcleaninganddecontaminationof

equipmentusedfordiagnosisandtreatment(asingleindividualmaybe

designatedforbothareas);

• inhealthcare,thedesignatedleadforcleaninginvolvesdirectorsof

nursing,matronsandtheICTorpersonsof similarstandinginall

aspectsof cleaningservices,fromcontractnegotiationandservice

planningtodeliveryatwardandclinicallevel.Inothersettings,the

designatedleadforcleaningwillneedtoaccessappropriateadviceon

allaspectsof cleaningservices;

• inhealthcare,matronsorpersonsof asimilarstandinghavepersonal

responsibilityandaccountabilityfordeliveringasafeandcleancare

environment;

• thenurseorotherpersoninchargeof anypatientorresidentarea

hasdirectresponsibilityforensuringthatcleanlinessstandardsare

maintainedthroughoutthatshift;

• allpartsof thepremisesfromwhichitprovidescarearesuitableforthe

purpose,keptcleanandmaintainedingoodphysicalrepairandcondition;

• thecleaningarrangementsdetailthestandardsof cleanlinessrequired

ineachpartof itspremisesandthatascheduleof cleaningfrequency

isavailableonrequest;

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• thereisadequateprovisionof suitablehandwashingfacilitiesand antimicrobialhandrubswhereappropriate;

• thereareeffectivearrangementsfortheappropriatecleaningof equipmentthatisusedatthepointof care,forexamplehoists,bedsand commodes–theseshouldbeincorporatedwithinappropriatecleaning, disinfectionanddecontaminationpolicies;and

• thesupplyandprovisionof linenandlaundryareappropriateforthe levelandtypeof care.

2.2 ‘Theenvironment’meansthetotalityof aserviceuser’ssurroundingswhen incarepremisesortransportedinavehicle.Thisincludesthefabricof the building,relatedfixturesandfittings,andservicessuchasairandwater supplies.Wherecareisdeliveredintheserviceuser’shome,thesuitability of theenvironmentforthatlevelof careshouldbeconsidered.

Policies on the environment

2.3 Premisesandfacilitiesshouldbeprovidedinaccordancewithbestpractice guidance.Thedevelopmentof localpoliciesshouldtakeaccountof infectionpreventionandcontroladvicegivenbyrelevantexpertoradvisory bodiesorbytheICT,andthisshouldincludeprovisionforliaisonbetween themembersof anyICTandthepersonswithoverallresponsibilityforthe managementof theserviceuser’senvironment.Policiesshouldaddress butnotberestrictedto:

• cleaningservices;

• buildingandrefurbishment,includingair-handlingsystems;

• wastemanagement;

• laundryarrangementsforusedandinfectedlinen;

• plannedpreventativemaintenance;

• pestcontrol;

• managementof drinkableandnon-drinkablewatersupplies;

• minimisingtheriskof Legionellabyadheringtonationalguidance;and

• foodservices,includingfoodhygieneandfoodbroughtintothecare settingbyserviceusers,staff andvisitors.


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Cleaning services

2.4 Thearrangementsforcleaningshouldinclude:

• cleardefinitionof specificrolesandresponsibilitiesforcleaning;

• clear,agreedandavailablecleaningroutines;

• sufficientresourcesdedicatedtokeepingtheenvironmentcleanandfit

forpurpose;

• consultationwithICTsorequivalentlocalexpertiseoncleaningprotocols

wheninternalorexternalcontractsarebeingprepared;and

• detailsof howstaff canrequestadditionalcleaning,bothurgentlyand

routinely.

Decontamination

2.5 Thedecontaminationleadshouldhaveresponsibilityforensuringthat policiesexistandthattheytakeaccountof bestpracticeandnational guidance.Theymaywishtoconsiderguidanceunderthefollowingheadings:

• Decontaminationof theenvironment–includingcleaningand

disinfectionof thefabric,fixturesandfittingsof abuilding(walls,floors,

ceilingsandbathroomfacilities)orvehicle.

• Decontaminationof equipment–includingcleaninganddisinfectionof

itemsthatcomeintocontactwiththepatientorserviceuser,butarenot

invasivedevices(egbeds,commodes,mattresses,hoistsandslings,

examinationcouches).

• Decontaminationof reusablemedicaldevices–includingcleaning,

disinfectionandsterilisationof invasivemedicaldevices.

• Reusablemedicaldevicesshouldbereprocessedatoneof thefollowing

threelevels:

– sterile(atpointof use); – sterilised(i.e.havingbeenthroughthesterilisationprocess); – clean(i.e.freeof visiblecontamination).

2.6 Thedecontaminationpolicyshoulddemonstratethat:

• itcomplieswithguidanceestablishingessentialqualityrequirementsand

aplanisinplaceforprogressiontobestpractice;

• decontaminationof reusablemedicaldevicestakesplaceinappropriate

facilitiesdesignedtominimisetherisksthatarepresent;

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• appropriateproceduresarefollowedfortheacquisition,maintenance andvalidationof decontaminationequipment;

• staff aretrainedincleaninganddecontaminationprocessesandhold appropriatecompetencesfortheirrole;and

• arecord-keepingregimeisinplacetoensurethatdecontamination processesarefitforpurposeandusetherequiredqualitysystems.

(Refer also to Outcome 11, Regulation 16 Safety, availability and suitability of equipment contained in CQC Guidance about compliance)


Providesuitableaccurateinformationoninfectionstoserviceusersand theirvisitors.

3.1 Areasrelevanttotheprovisionof suchinformationinclude:

• generalprinciplesonthepreventionandcontrolof infectionandkey aspectsof theregisteredprovider’spolicyoninfectionpreventionand control,whichtakesintoaccountthecommunicationneedsof the serviceuser;

• therolesandresponsibilitiesof particularindividualssuchascarers, relativesandadvocatesinthepreventionandcontrolof infection,to supportthemwhenvisitingserviceusers;

• supportingserviceusers’awarenessandinvolvementinthesafe provisionof care;

• theimportanceof compliancebyvisitorswithhandhygiene;

• theimportanceof compliancewiththeregisteredprovider’spolicy onvisiting;

• reportingfailuresof hygieneandcleanliness;

• explanationsof incident/outbreakmanagement.

3.2 Informationshouldbedevelopedwithlocalserviceuserrepresentative organisations,whichcouldincludeLocalInvolvementNetworks(LINks)and PatientAdviceandLiaisonServices(PALS).

(Refer also to Outcome 1, Regulation 17 Respecting and involving service users contained in CQC Guidance about compliance)

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Providesuitableaccurateinformationoninfectionstoanypersonconcer ned withprovidingfurthersuppor tornursing/medicalcareinatimelyfashion.

4.1 Aregisteredprovidershouldensurethat:

• accurateinformationiscommunicatedinanappropriatemanner;

• thisinformationfacilitatestheprovisionof optimumcare,minimisingthe riskof inappropriatemanagementandfurthertransmissionof infection; and

• wherepossible,informationaccompaniestheserviceuser.

4.2 Provisionof relevantinformationacrossorganisationalboundariesis coveredbytheregulationrequirement‘Co-operatingwithotherproviders’. Dueattentionshouldbepaidtoserviceuserconfidentialityasoutlinedin nationalguidanceandtrainingmaterial.8



Ensurethatpeoplewhohaveordevelopaninfectionareidentified promptly andreceivetheappropriatetreatmentandcaretoreducetheriskof passing ontheinfectiontootherpeople.

5.1 Registeredproviders,excludingpersonalcareproviders,shouldensure thatadviceisreceivedfromsuitablyinformedpractitionersandthat,if advised,registeredprovidersshouldinformtheirlocalhealthprotectionunit of anyoutbreaksorseriousincidentsrelatingtoinfection.

5.2 Arrangementstopreventandcontrolinfectionshoulddemonstratethat responsibilityforinfectionpreventionandcontroliseffectivelydevolvedto allgroupsintheorganisationinvolvedindeliveringcare.

8 Furtheradviceontheprinciplesforappropriateinformation-sharingcanbefoundin Confidentiality: NHS Code of Practice; The Care Record Guarantee; and The Social Care Record Guarantee. Trainingmaterialsoninformationgovernancecanbefoundin NHS Information Governance Training Tool.

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Ensurethatallstaff andthoseemployedtoprovidecareinallsettingsare fullyinvolvedintheprocessof preventingandcontrollinginfection.

6.1 Aregisteredprovidershould,sofarasisreasonablypracticable,ensure thatitsstaff,contractorsandothersinvolvedintheprovisionof care co-operatewithit,andwitheachother,sofarasisnecessarytoenablethe registeredprovidertomeetitsobligationsundertheCode.

6.2 Infectionpreventionandcontrolwouldneedtobeincludedinthejob descriptionsandbeincludedintheinductionprogrammeandstaff updates of allemployees(includingvolunteers).Contractorsworkinginservice userareaswouldneedtobeawareof anyissueswithregardtoinfection preventionandcontrolandobtain’permissiontowork‘.Confidentialitymust bemaintained.

6.3 Wherestaff undertakeprocedures,whichrequireskillssuchasaseptic technique,staff mustbetrainedanddemonstrateproficiencybeforebeing allowedtoundertaketheseproceduresindependently.


Provideorsecureadequateisolationfacilities.

7.1 Ahealthcareregisteredproviderdeliveringin-patientcareshouldensure thatitisabletoprovide,orsecuretheprovisionof,adequateisolation precautionsandfacilities,asappropriate,sufficienttopreventorminimise thespreadof infection.Thismayincludefacilitiesinadaycaresetting.

7.2 Policiesshouldbeinplacefortheallocationof patientstoisolation facilities,basedonalocalriskassessment.Theassessmentcouldinclude considerationof theneedforspecialventilatedisolationfacilities.Sufficient staff shouldbeavailabletocarefortheserviceuserssafely.

7.3 Registeredprovidersof accommodationshouldensurethattheyareable toprovideorsecurefacilitiestophysicallyseparatetheserviceuserfrom otherresidentsinanappropriatemannerinordertominimisethespread of infection.

7.4 Carehomesarenotexpectedtohavededicatedisolationfacilitiesfor serviceusersbutareexpectedtoimplementisolationprecautionswhena serviceuserissuspectedorknowntohaveatransmissibleinfection.

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Secureadequateaccesstolaboratorysuppor tasappropriate.

8.1 Aregisteredprovidershouldensurethatlaboratoriesthatareusedto provideamicrobiologyserviceinconnectionwitharrangementsfor infectionpreventionandcontrolhaveinplaceappropriateprotocolsand thattheyoperateaccordingtothestandardsrequiredbytherelevant nationalaccreditationbodies.Inadultsocialcare,theserviceuser’s GeneralPractitionerwillarrangesuchtestingwhennecessaryforthe treatmentandmanagementof disease.

8.2 Protocolsshouldinclude:

• amicrobiologylaboratorypolicyforinvestigationandsurveillanceof healthcareassociatedinfections;and

• standardlaboratoryoperatingproceduresfortheexaminationof specimens.


Haveandadheretopolicies,designedfortheindividual’scareandprovider organisations,thatwillhelptopreventandcontrolinfections.

9.1 Aregisteredprovidershould,inrelationtopreventing,reducingand controllingtherisksof infections,haveinplacetheappropriatepolicies concerningthemattersmentionedinatoybelow.Allpoliciesshouldbe clearlymarkedwithareviewdate.

9.2 AguideisgiveninTable3astowhichpoliciesmaybeappropriatetothe regulatedactivities.Adecisionshouldbemadelocallyfollowingarisk assessment.

9.3 Anyregisteredprovidershouldhavepoliciesinplacerelevanttothe regulatedactivityitprovides.Eachpolicyshouldindicateownership(i.e. whocommissionedandretainsmanagerialresponsibility),authorshipand bywhomthepolicywillbeapplied.Implementationof policiesshouldbe monitoredandthereshouldbeevidenceof arollingprogrammeof audit andadateforrevisionstated.

a. Standard infection prevention and control precautions

• Policyshouldbebasedonevidence-basedguidelines,includingthose

onhandhygieneatthepointof careandtheuseof personalprotective

equipment.

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• Policyshouldbeeasilyaccessibleandbeunderstoodbyallgroupsof staff,serviceusersandthepublic.

• Compliancewiththepolicyshouldbeaudited.

b. Aseptic technique Whereasepticproceduresareperformed:

• clinicalproceduresshouldbecarriedoutinamannerthatmaintainsand promotestheprinciplesof asepsis;

• education,trainingandassessmentintheaseptictechniqueshouldbe providedtoallpersonsundertakingsuchprocedures;

• thetechniqueshouldbestandardisedacrosstheorganisation;and

• anauditshouldbeundertakentomonitorcompliancewiththetechnique.

c. Outbreaks of communicable infection

• Thedegreeof detailinthepolicyshouldreflectlocalcircumstances. Alowrisk,single-specialtyfacilityorproviderof primarycarewillnot requirethesamearrangementsasthoseprovidingthefullrangeof medicalandsurgicalcare.

• Professionaladviceoninfectionpreventionandcontrolforregulated activitiesmaybedrawnfromanumberof expertsources.Table2 outlinesthemostlikelyarrangementsforthedifferentregulated activities.

• Policiesforoutbreaksof communicableinfectionshouldincludeinitial assessment,communication,managementandorganisation,plus investigationandcontrol.

• Thecontactdetailsof thoselikelytobeinvolvedinoutbreak

managementshouldbereviewedatleastannually.

• Allregisteredprovidersshouldreportsignificantoutbreaksof infection totheirlocalhealthprotectionunit,includingoutbreaksinserviceusers whoaredetainedundertheMentalHealthAct1983,if advisedtodoso bysuitablyinformedpractitioners.

d. Isolation of service users with an infection (see also criterion 7)

• Theisolationpolicyshouldbeevidencebasedandreflectlocalrisk assessment9.

9 HealthandSafetyExecutive(2006)Five steps to risk assessment.INDG163(rev2). London:HSE.

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• Indicationsforisolationshouldbeincludedinthepolicy,asshould proceduresfortheinfectionpreventionandcontrolmanagementof serviceusersinisolation.

• Informationonisolationshouldbeeasilyaccessibleandunderstoodby allgroupsof staff,serviceusersandthepublic.

e. Safe handling and disposal of sharps Relevantconsiderationsinclude:

• riskmanagementandtraininginthemanagementof mucousmembrane exposureandsharpsinjuriesandincidents;

• provisionof medicaldevicesthatincorporatesharpsprotection mechanismswherethereareclearindicationsthattheywillprovidesafe systemsof workingforstaff;

• apolicythatiseasilyaccessibleandunderstoodbyallgroupsof staff;

• safeuse,securestorageanddisposalof sharps;and

• auditingof policycompliance.

f. Prevention of occupational exposure to blood-borne viruses (BBVs), including prevention of sharps injuries

MeasurestoavoidexposuretoBBVs(hepatitisBandCandHIV)should include:

• immunisationagainsthepatitisB,assetoutinImmunisation against infectious disease,betterknownas‘TheGreenBook’(publishedbythe Departmentof Health);

• thewearingof glovesandotherprotectiveclothing;

• thesafehandlinganddisposalof sharps,includingtheprovisionof medicaldevicesthatincorporatesharpsprotectionwherethereareclear indicationsthattheywillprovidesafesystemsof workingforstaff;and

• measurestoreducerisksduringsurgicalprocedures.

g. Management of occupational exposure to BBVs and post-exposure prophylaxis

Managementshouldensure:

• thatanymemberof staff whohasasignificantoccupationalexposure tobloodorbodyfluidsisawareof theimmediateactionrequiredandis referredappropriatelyforfurthermanagementandfollow-up;

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• provisionof clearinformationforstaff aboutreportingpotential occupationalexposure–inparticulartheneedforpromptaction followingaknownorpotentialexposuretoHIVorhepatitisB;and

• arrangementsforpost-exposureprophylaxisforhepatitisBandHIV.

(Refer also to Outcome 12, Regulation 21 Requirements relating to workers contained in CQC Guidance about compliance)

h. Closure of rooms, wards, departments and premises to new admissions

• Asystemshouldbeinplacefortheprovisionof advicefromthelocal healthprotectionunit/DIPC/ICTfortheregisteredprovider.

• Thereshouldbeclearcriteriainrelationtoclosuresandre-opening.

• Thepolicyshouldaddresstheneedforenvironmental decontamination priortore-opening.

i. Disinfection Theuseof disinfectantsisalocaldecision,andshouldbebasedon

currentacceptedgoodpractice.

j. Decontamination of reusable medical devices Decontaminationinvolvesacombinationof processesandincludes

cleaning,disinfectionandsterilisation,accordingtotheintendeduseof the device.Thisaimstorenderareusableitemsafeforfurtheruseonservice usersandforhandlingbystaff.

• Effectivedecontaminationof reusablemedicaldevicesisanessential partof infectionriskcontrolandisof specialimportancewhenthe devicecomesintocontactwithserviceusersortheirbodyfluids.There shouldbeasystemtoprotectserviceusersandstaff thatminimisesthe riskof transmission of infectionfrommedicaldevices.Thisrequiresthat thedeviceorinstrumentsetcanbeclearlylinkedinatraceablefashion totheindividualprocesscyclethatwasusedtodecontaminateit,such thatthesuccess of thatcycleinrenderingthedevicesafeforreusecan beverified.

• Reusablemedicaldevicesshouldbedecontaminatedinaccordancewith manufacturers’instructionsandcurrentnationalorlocalbestpractice guidance.Thismustensurethatthedevicecomplieswiththe‘Essential Requirements’providedintheMedicalDevicesRegulations2002where applicable.Thisrequiresthatthedeviceshouldbecleanand,where appropriate,sterilised attheendof thedecontaminationprocessand maintainedinaclinicallysatisfactor yconditionuptothepointof use.

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• Managementsystemsshouldensureadequatesuppliesof reusable

medicaldevices,particularlywherespecificdevicesareessentialtothe

continuityof care.

• Reusablemedicaldevicesemployedininvasiveprocedures,for

example,endoscopesandsurgicalinstrumentshavetobeeither

individuallyidentifiableoridentifiedtoasetof whichtheyarea

consistentmember,throughouttheuseanddecontaminationcyclein

ordertoensuresubsequenttraceability.

• Systemsshouldalsobeimplementedtoenabletheidentificationof

serviceusersonwhomthemedicaldeviceshavebeenused.

• Decontaminationof single-patientusedevices,i.e.thatequipment

designatedforuseonlybyonepatient,shouldbesubjecttolocalpolicy

andmanufacturersinstructions.


k. Single-use medical devices Policiesshouldbeinplaceforhandlingdevicesdesignedforsingleuseonly.

Single-usemedicaldevicesshouldbeusedonceanddisposedof safely.

l. Antimicrobial prescribing

• PrescribingshouldgenerallybeharmonisedwiththatintheBritish

National Formulary.However,localguidelinesmayberequiredincertain

circumstances.

• Alllocalguidelinesshouldincludeinformationonaparticulardrug’s

regimenandduration.

• Proceduresshouldbeinplacetoensureprudentprescribingand

antimicrobialstewardship.Thereshouldbeanongoingprogrammeof

audit,revisionandupdate.Inhealthcarethisisusuallymonitoredbythe

antimicrobialmanagementteamorlocalprescribingadvisors.

m. Reporting of infections to the Health Protection Agency or local authority Mandatory reporting of healthcare associated infections to the Health

Protection Agency

• ThisincludesarequirementforNHSTrustChief Executivestoreport

allcasesof MRSAbacteraemiaandallcasesof Clostridium difficile

infectioninpatientsagedtwoyearsorolderthatareidentifiedintheir

institution.Theindependentsectorhospitalsarealsoexpectedtoreport

casesinasimilarmanner.Therequirementsof thissystemwillvary

fromtimetotimeasdirectedbytheDepartmentof Health.

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Health Protection (Notification) Regulations 2010

• Theserequireattendingdoctors(registeredmedicalpractitioners)to notifytheProperOfficerof thelocalauthorityof casesof specified infectiousdiseaseorof otherinfectiousdiseaseorcontamination,which present,orcouldpresent,significantharmtohumanhealth,toallow promptinvestigationandresponse.Theregulationsalsorequirediagnostic laboratoriestestinghumansamplestonotifytheHealthProtectionAgency of theidentificationof specifiedcausativeagentsof infectiousdisease.

n. Control of outbreaks and infections associated with specific alert organisms Thisshouldtakeaccountof localepidemiologyandriskassessment.

Theseinfectionsmustinclude,asaminimum,MRSA,respiratoryinfection, diarrhoealoutbreaks,Clostridium difficileinfectionandtransmissible spongiformencephalopathies.

MRSA Thepolicyshouldmakeprovisionfor:

• screeningof NHSpatientsonemergencyorrelevantelectiveadmission toaunitthatprovidessurgical,diagnosticorothermedicalcare.The arrangementsforundertakingscreeningwillbesubjecttolocalagreement;

• suppressionregimensforcolonisedpatientswhenappropriate;

• isolationof infectedorcolonisedpatients;

• transferof infectedorcolonisedpatientswithinorganisationsortoother carefacilities;

• antibiotic prophylaxisforsurgery;and

• undertakingarootcauseanalysisonpatientswithaMRSAbacteraemia.

Clostridium difficile Thepolicyshouldmakeprovisionfor:

• surveillanceof Clostridium difficileinfection;

• diagnosticcriteria;

• isolationof infectedserviceusersandcohortnursing;

• environmentaldecontamination;

• antibiotic prescribingpolicies;and

• contraindicationof anti-motilityagents.

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Glycopeptide resistant enterococci (GRE) Thepolicyshouldmakeprovisionfor:

• identificationof high-riskgroups;

• isolationandpreventionof cross-infection;and

• prophylaxisforsurgicalandinvasiveprocedures.

Acinetobacter, extended-spectrum beta lactamase (ESBLs) and other antibiotic-resistant bacteria Thepolicyshouldmakeprovisionfor:

• surveillanceof identifiedpatientsatriskandof high-riskenvironments; and

• proceduresformanaginginfectedpatientstopreventspreadofinfection.

Viral haemorrhagic fevers (VHF) Thepolicyshouldmakeprovisionfor:

• appropriatestaff tobeawareof thespecialmeasurestobetakenfor nursingVHFpatients,andtobeproperlytrainedintheapplicationof full isolationprocedures;

• patientriskassessmentandcategorisation;

• confirmedcasestobehandledunderfullisolationmeasuresinahighsecurityinfectiousdiseasesunitorequivalent;

• handlingof patientspecimensattheappropriatecontainmentlevel;

• follow-upofallstaff incontactwiththepatientateverystageofcare;and

• specialmeasuresforthehandlingof allwasteandlaundry.

Creutzfeldt-Jakob disease (CJD), variant CJD (vCJD) and other human prion diseases Thepolicyshouldmakeprovisionforthemanagementof patientswith,or atincreasedriskof,CJD/vCJDandotherhumanpriondiseases.

Relevant policies for other specific alert organisms Thespecificalertorganismsthatfollowmayberelevanttoanyunit admitting,ortreatingasout-patients.

Control of tuberculosis, including multidrug-resistant tuberculosis:

• isolationof infectiouspatients;

• transferof infectiouspatientswithincareorganisationsortoother carefacilities;

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-


• contacttracing;and

• treatmentcompliance.

Respiratory viruses:

• alertsystemforsuspectedcases;

• isolationcriteria;and

• infectionpreventionandcontrolmeasures.

Diarrhoeal infections:

• isolationcriteria;

• infectionpreventionandcontrolmeasures;and

• cleaninganddisinfectionpolicy.

o. CJD/vCJD – handling of instruments and devices Adviceonthehandlingof instrumentsanddevicesinprocedureson

patientswithknownorsuspectedCJD/vCJD,oratincreasedriskof CJD/ vCJD,includingdisposal/quarantineprocedures,isprovidedinguidance fromtheAdvisoryCommitteeonDangerousPathogens(ACDP)TSE WorkingGroup.


p. Safe handling and disposal of waste Therisksfromwastedisposalshouldbeproperlycontrolled.Inpractice,in

relationtowaste,thisinvolves:

• assessingrisk;

• developingappropriatepolicies;

• puttingarrangementsinplacetomanagerisks;

• monitoring,auditingandreviewingthewayinwhicharrangementswork; and

• beingawareof statutoryrequirementsand;legislativechangeand managingcompliance.

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Precautionsinconnectionwithhandlingwasteshouldinclude:

• trainingandinformation(includingdefinitionandclassificationof waste);

• personalhygiene;

• segregationandstorageof waste;

• theuseof appropriatepersonalprotectiveequipment;

• immunisation;

• appropriateproceduresforhandlingsuchwaste;

• appropriatepackagingandlabelling;

• suitabletransporton-siteandoff-site;

• clearproceduresfordealingwithaccidents,incidentsandspillages;and

• appropriatetreatmentanddisposalof suchwaste.

Systemsshouldbeinplacetoensurethattheriskstoserviceusers fromexposuretoinfectionscausedbywastepresentintheenvironment areproperlymanaged,andthatdutiesunderenvironmentallaware discharged.Themostimportantof theseare:

• dutyof careinthemanagementof waste;

• dutytocontrolpollutingemissionstotheair;

• dutytocontroldischargestosewers;

• obligationsof wastemanagers;

• collectionof dataandobligationstocompleteandretaindocumentation

includingrecordkeeping;and

• requirementtoprovidecontingencyplansandhaveemergency

proceduresinplace.


q. Packaging, handling and delivery of laboratory specimens Biologicalsamples,culturesandothermaterialsshouldbetransportedin

amannerthatensuresthattheydonotleakintransitandarecompliant withcurrentlegislation.Staff whohandlesamplesmustbeawareof the needtocorrectlyidentify,labelandstoresamplespriortoforwardingto laboratories.Inaddition,theymustbeawareof theproceduresneeded whenthecontainerorpackagingbecomessoiledwithbodyfluids.

33


r. Care of deceased persons Appropriateproceduresshouldinclude:

• riskassessmentof potentialhazards;

• theprovisionof appropriatefacilitiesandaccommodation;

• safeworkingpractices;

• arrangementsforvisitors;

• information,instruction,trainingandsupervision;and

• healthsurveillanceandimmunisation(whereappropriate).

s. Use and care of invasive devices Policyshouldbebasedonevidence-basedguidelinesandshouldbeeasily

accessiblebyallrelevantcareworkers.Compliancewithpolicyshouldbe audited.Informationonpolicyshouldbeincludedininfectionprevention andcontroltrainingprogrammesforallrelevantstaff groups.


t. Purchase, cleaning, decontamination, maintenance and disposal of equipment

Policiesforthepurchase,cleaning,decontamination,maintenanceand disposalof allequipmentshouldtakeintoaccountinfectionprevention andcontroladvicethatisgivenbyrelevantexpertsoradvisorybodiesor bytheICT.

u. Surveillance and data collection Forallappropriatehealthcaresettings,thereshouldbeevidenceof

localsurveillanceanduseof comparativedata,whereavailable,in ordertomonitorinfectionratesandtoassesstherisksof infection.This evidenceshouldincludedataonalertorganisms,andotherinfections whereappropriate,alertconditionsandwoundinfectionperclinicalunit orspecialty.Whenappropriateorwheretheyexist,recogniseddefinitions shouldbeused.

ElectronicreportingtotheHealthProtectionAgencyof clinicallaboratory isolatesisrecommendedwheretheappropriateinformationtechnologyis inplace.

Thereshouldalsobetimelyfeedbacktoclinicalunits,witharecordof achievementsandactionstakenasaresultof surveillance.Post-discharge surveillanceof surgicalsiteinfectionshouldbeconsideredand,where practicable,shouldbeimplemented.

34


v. Dissemination of information Thereshouldbealocalprotocolforthedisseminationof informationabout

infectionsbetweencareorganisationsconcer ninganindividualservice user.Thisistofacilitatesurveillanceandoptimalmanagementof infections inthewidercommunity.Guidanceondataprotectionlegislationalsoneeds tobeobserved.


w. Isolation facilities Thereshouldbeapolicyconcer ningtheappropriateprovisionof isolation

facilities.Thisshouldaddress:

• potentialsourcesof infection;

• theuseof protectivemeasuresandequipment;and

• themanagementof outbreaks.

x. Uniform and dress code Uniformandworkwearpoliciesensurethatclothingwornbystaff

whencarryingouttheirdutiesiscleanandfitforpurpose.Particular considerationshouldbegiventoitemsof attirethatmayinadvertently comeintocontactwiththepersonbeingcaredfor.Uniformanddresscode policiesshouldspecificallysuppor tgoodhandhygiene.

y. Immunisation of service users Registeredprovidersshouldensurethatpoliciesandproceduresarein

placewithregardtotheimmunisationstatusof serviceuserssuchthat:

• thereisarecordof allimmunisationsgiven;

• theimmunisationstatusandeligibilityforimmunisationof serviceusers areregularlyreviewedinlinewithImmunisation against infectious disease (‘TheGreenBook’)andotherDepartmentof Healthguidance; and

• followingareviewof therecordof immunisations,allserviceusers areofferedfurtherimmunisationasneeded,accordingtothenational schedule.

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Ensure,sofarasisreasonablypracticable,thatcareworkersarefreeof and areprotectedfromexposuretoinfectionsthatcanbecaughtatworkand thatallstaff aresuitablyeducatedinthepreventionandcontrolof infection associatedwiththeprovisionof healthandsocialcare.

10.1Registeredprovidersshouldensurethatpoliciesandproceduresarein placeinrelationtothepreventionandcontrolof infectionsuchthat:

• allstaff canaccessoccupationalhealthservicesoraccessappropriate occupationalhealthadvice;

• occupationalhealthpoliciesonthepreventionandmanagementof communicableinfectionsincareworkersareinplace;

• decisionsonofferingimmunisationshouldbemadeonthebasisof a localriskassessmentasdescribedinImmunisation against infectious disease(‘TheGreenBook’).Employersshouldmakevaccinesavailable freeof chargetoemployeesif ariskassessmentindicatesthatitis needed(COSHHRegulations2002);

• thereisarecordof relevantimmunisations;

• theprinciplesandpracticeof preventionandcontrolof infectionare includedininductionandtrainingprogrammesfornewstaff.The principlesinclude:ensuringthatpoliciesareuptodate;feedbackfrom auditresults;examplesof goodpractice;andactionneededtocorrect poorpractice;

• thereisappropriateongoingeducationforexistingstaff (including supportstaff,volunteers,agency/locumstaff andstaff employedby contractors),whichshouldincorporatetheprinciplesandpracticeof preventionandcontrolof infection.

• thereisarecordof trainingandupdatesforallstaff;and

• theresponsibilitiesof eachmemberof staff forthepreventionand controlof infectionarereflectedintheirjobdescriptionandinany personaldevelopmentplanorappraisal.

Occupational health services 10.2 Occupationalhealthservicesforstaff shouldinclude:

• risk-basedscreeningforcommunicablediseasesandassessment of immunitytoinfectionafteraconditionalofferof employmentand ongoinghealthsurveillance;

36


• offerof relevantimmunisations;and

• havingarrangementsinplaceforregularlyreviewingtheimmunisation statusof careworkersandprovidingvaccinationstostaff asnecessary inlinewithImmunisation against infectious disease(‘TheGreenBook’) andotherDepartmentof Healthguidance.

10.3Occupationalhealthservicesinrespectof BBVsshouldinclude:

• havingarrangementsforidentifyingandmanaginghealthcarestaff infectedwithhepatitisBorCorHIVandadvisingaboutfitnessforwork andmonitoringasnecessary,inlinewithDepartmentof Healthguidance;

• liaisingwiththeUK Advisory Panel for Healthcare Workers Infected with Blood-borne Viruseswhenadviceisneededonproceduresthatmay becarriedoutbyBBV-infectedcareworkers,orwhenadviceonpatient tracing,notificationandofferof BBVtestingmaybeneeded;

• ariskassessmentandappropriatereferralafteraccidentaloccupational exposuretobloodandbodyfluids;and

• managementof occupationalexposuretoinfection,whichmayinclude provisionforemergencyandout-of-hourstreatment,possiblyin conjunctionwithaccidentandemergencyservicesandon-callinfection preventionandcontrolspecialists.Thisshouldincludeaspecificrisk assessmentfollowinganexposureproneprocedure.

(Refer also to Outcome 12, Regulation 21 Requirements relating to workers contained in CQC Guidance about compliance)

37


Part 4: Guidance tables�

Thesetablesaredesignedtohelpregisteredproviders,theDIPC(NHSprovider organisations)andIPCLeads(adultsocialcare,primarydentalcareand primarymedicalcare,andindependentsectorambulanceproviders)decide howtheCodeandrelatedguidanceappliestotheregisteredactivitiesandtype of servicetheyprovide.Furtherguidanceontheactivitiesthatarecoveredby registrationareavailableatwww.cqc.org.uk

Becauseof thewiderangeof servicesprovidedinhealthcareandadultsocial care,registeredprovidersshouldcarryouttheirownriskassessmentstohelp themdecidetheelementstobeincludedintheirpoliciesorwhetherornota policyisrequiredatall.Theywillneedtobeabletojustifytheirdecisions.

Table1 Theapplicationof theCodeof Practicetoregulatedactivities

Table2 Aguidetopotentialsources of professionalinfectionprevention andcontroladvice

Table3 Policiesappropriatetoregulatedactivities

38

http://www.cqc.org.uk

Part4:Guidancetables

Table 1 – The application of the Code of Practice to regulated activities Thistableprovidesaguideastowhichcriteriamayapplytoeachregulatedactivity.Thisisamatterforlocaldetermination.

Regulated activities

Personal care

Accommodation forpersonswho

requirenursingor

Accommodation forpersonswho requiretreatment

Accommodation andnursingor personalcare

Treatment of

disease,

Assessment ormedical treatment

Surgical procedures

Diagnostic and

screening

Management of supplyof bloodand

Transpor t services, triageand

Maternity and

midwifery

Termination of

pregnancies

Services in

slimming

Nursing care

Family planning services

personalcare forsubstance misuse

inthefurther educationsector

disorderor injury

forpersons detained underthe

procedures bloodderived productsetc

medical advice

provided

services clinics

Mental remotely HealthAct Ω

1983

1 Systemsto manageand monitorthe prevention andcontrolof infection.These systemsuserisk assessments and considerhow susceptible serviceusersare andanyrisksthat theirenvironment andotherusers mayposetothem

3 3 3 3 3 3 3 3 3 3 3 3 3 3 3

2 Provideand

n maintainaclean

crit

erio andappropriate

environment

ance

inmanaged premisesthat facilitatesthe

3 3 3 3 3 3 3 3 3 3 3 3 3

Co

mp

li prevention andcontrolof infections

3 Providesuitable accurate informationon infectionsto serviceusersand theirvisitors

3 3 3 3 3 3 3 3 3 3 3 3 3

4 Providesuitable accurate informationon infectionstoany personconcerned withproviding furthersupportor nursing/medical careinatimely fashion

3 3 3 3 3 3 3 3 3 3 3 3 3 3 3

§SeeTable3ΩAppliestotransportandtriageservicesdeliveredatsite#Doesnotapplytoprimarydentalcare♣Doesnotapplytoprimarydental/medicalcare

39


Table 1 – The application of the Code of Practice to regulated activities continued Thistableprovidesaguideastowhichcriteriamayapplytoeachregulatedactivity.Thisisamatterforlocaldetermination.


Personal care


requirenursingor


Accommodation andnursingor personalcare

Treatment of

disease,


Surgical procedures

Diagnostic and

screening


Transpor t services, triageand

Maternity and

midwifery

Termination of

pregnancies

Services in

slimming

Nursing care


personalcare forsubstance misuse

inthefurther educationsector

disorderor injury


procedures bloodderived productsetc

medical advice

provided

services clinics


1983

5 Ensurethat peoplewho haveordevelop aninfectionare identifiedpromptly andreceive theappropriate treatmentand

3 3 3 3 3 3 3 3 3 3 3 3 3 3 caretoreduce theriskof passingonthe infectiontoother people

6 Ensurethatall staff andthose

Co

mp

lian

ce c

rite

rio

n

employedto providecarein allsettingsare fullyinvolved intheprocess of preventing andcontrolling infection

3 3 3 3 3 3 3 3 3 3 3 3 3 3

7 Provideor secure adequate isolationfacilities ♣

3 3 3 3 3 3

8 Secureadequate access to laboratory supportas appropriate#

3 3 3 3 3 3 3 3 3 3

9 Haveandadhere topolicies, designedforthe individual’scare andprovider organisations, thatwillhelp topreventand controlinfections

§ 3 3 3 3 3 3 3 3 3 3 3 3 3 3


40


Table1–Theapplicationof theCodeof Practicetoregulatedactivitiescontinued Thistableprovidesaguideastowhichcriteriamayapplytoeachregulatedactivity.Thisisamatterforlocaldetermination.


Personal Accommodation Accommodation Accommodation Treatment Assessment Surgical Diagnostic Management Transpor t Maternity Termination Services Nursing Family care forpersonswho forpersonswho andnursingor of ormedical procedures and of supplyof services, and of in care planning

requirenursingor requiretreatment personalcare disease, treatment screening bloodand triageand midwifery pregnancies slimming services personalcare forsubstance inthefurther disorderor forpersons procedures bloodderived medical services clinics

misuse educationsector injury detained productsetc advice underthe provided


1983

Co

mp

lian

ce c

rite

rio

n

10 Ensure,sofar asisreasonably practicable,that careworkers arefreeof and areprotected fromexposure toinfectionsthat canbecaughtat workandthatall staff aresuitably educatedin theprevention andcontrol

3 3 3 3 3 3 3 3 3 3 3 3 3 3 3

of infection associatedwith theprovisionof healthandsocial care


41


Table2–Aguidetopotentialsourcesof professionalinfectionpreventionandcontroladvice10


Personal care


requirenursingor personalcare


forsubstance misuse

Accommodation andnursingor personalcare inthefurther

educationsector

Treatment of

disease, disorderor

injury



Mental HealthAct

Surgical procedures

Diagnostic and

screening procedures


bloodderived productsetc

Transpor t services, triageand medical advice

provided remotely

Maternity and

midwifery services

Termination of

pregnancies

Services in

slimming clinics

Nursing care


1983

Directorof Infection Prevention andControl 3 3 3 3 ● 3 3 3 orInfection Preventionand ControlLead

Infection controlnurse/ infectioncontrol practitioner

3 3 3 ● 3

Consultant microbiologist 3 3 3 3 3 3 3 Designatedsite leadforinfection (maynotalways ¥ 3 3 3 3 3 3 3 3 3 3 3 3 beahealthcare

gro

up

worker)

Accessto

al consultant in

ssio

n communicable diseasecontrol/ 3 3 3 3 3 3 3 3 ● 3 3

fe localHealth

Pro ProtectionUnit

Fullyconstituted infectioncontrol teamand 3 3 3 ● 3 infectioncontrol committee♣

Primarycaretrust infectioncontrol suppor t

3 3 3 3 3 3

Primary healthcare teams 3 3 3 3 3 3 3 Occupational healthservices (consultwhenrisk of transmission fromcareworkers toserviceuseror viceversa)

3 3 3 3 3 3 3 3 3 3 3 3 3 3 3

10Wherenospecialistoccupationalhealthserviceadviceexists, ● Relevanttoacuteandindependentsectorambulanceproviders ¥Providersof domiciliarycarewouldneedtohaveadesignatedlead

advicemaybesoughtfromserviceuser’sgeneralpractitioner Appliestoprimarydental/medicalcare ♣ Doesnotapplytoprimarydental/medicalcareorindependentsector ambulanceproviders

42


Table3–Policiesappropriatetoregulatedactivities

Compliance with criterion 9


Personal care




forsubstance misuse


educationsector

Treatment of

disease, disorderor

injury



Mental HealthAct

Surgical procedures

Diagnostic and





provided remotely Ω

Maternity and

midwifery services

Termination of

pregnancies

Services in

slimming clinics

Nursing care


1983

Standardinfection

a prevention andcontrol 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 precautions

b Aseptictechnique 3 3 3 3 3 3 3 3 3 3 3 3 3 3 Outbreaks of

c communicable 3 3 3 3 3 3 ▲ 3 3 3 infection#

Isolationof d serviceuserswith 3 3 3 3 3 3 3 3 3 3

Po

licie

s

aninfection#

e Safehandling anddisposalof sharps

3 3 3 3 3 3 3 3 3 3 3 3 3 3 3

f

Preventionof occupational exposureto blood-borne viruses,inc preventionof sharpsinjuries

3 3 3 3 3 3 3 3 3 3 3 3 3 3 3

g

Management of occupational exposureto blood-borne virusesand post-exposure prophylaxis

3 3 3 3 3 3 3 3 3 3 3 3 3 3 3

Closureof

h rooms,wards, departmentsand premisestonew

3 3 3 3 3 3 3 3 admissions♣

i Disinfection★ 3 3 3 3 3 3 3 3 3 3 3 3 3 Decontamination

j of reusable medicaldevices 3 3 3 3 3 3 3 3 3 3 3 3 ★

k Single-use medicaldevices ★

3 3 3 3 3 3 3 3 3 3 3 3 3 3 3

ΩAppliestotransportandtriageservicedeliveredatsite▲Appliestoinvasivediagnosticprocedures★Decontaminationleadwillberesponsiblefortheseareas

♣Unlikelyordoesnotapplytoprimarydental/medicalcare#Doesnotapplytoprimarydentalcare

43


Table3–Policiesappropriatetoregulatedactivitiescontinued



Personal care




forsubstance misuse


educationsector

Treatment of

disease, disorderor

injury



Mental HealthAct

Surgical procedures

Diagnostic and






Maternity and

midwifery services

Termination of

pregnancies

Services in

slimming clinics

Nursing care


1983

l Antimicrobial prescribing 3 3 3 3 3 3 3 3 3 Reportingof infectionstothe

m HealthProtection Agencyorlocal

3 3 3 authority♣#

Controlof outbreaks

n andinfections associatedwith 3 3 3 3 3 3 3 specificalert organisms#

CJD/vCJD–

o handlingof instrumentsand 3 3 3 3

Po

licie

s

devices#

p Safehandlingand disposalof waste 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3

q

Packaging, handlingand deliveryof laboratory specimens#

3 3 3 3 3 3 3 3 3 3 3 3

r Careof deceased persons♣ 3 3 3 3 3 3 3 3 3 3 3

s Useandcareof invasivedevices# 3 3 3 3 3 3 3 3 3 3 3 3 3 3 Purchase,

t

cleaning, decontamination, maintenance 3 3 3 3 3 3 3 3 3 3 3 3 3 3 anddisposalof equipment★

u Surveillanceand datacollection # 3 3 3 3 3



44


Table3–Policiesappropriatetoregulatedactivitiescontinued



Personal care




forsubstance misuse


educationsector

Treatment of

disease, disorderor

injury



Mental HealthAct

Surgical procedures

Diagnostic and






Maternity and

midwifery services

Termination of

pregnancies

Services in

slimming clinics

Nursing care


1983

Po

licie

s

v Disseminationof information 3 3 3 3 3 3 3 3 3 3 3

w Isolationfacilities ♣ 3 3 3 3 3 3 3 3 3

x Uniformand dresscode 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3

y Immunisationof serviceusers# 3 3 3 3 3 3 3 3 3



45

The Health and Social Care Act 2008 Code of Practice on the prevention and control of infections

Appendix A: Examples of interpretation for adult social care It is essential to read the following examples alongside the guidance under each criterion in Part 3 and not just selective parts.

The examples demonstrate how a proportionate approach to the guidance could apply in certain types of adult social care services. They are examples only and registered providers and IPC Leads should carry out their own risk assessments to help them decide which parts of the criteria apply to their particular service.

Registered providers and IPC Leads will make sure that they can provide evidence to support any decision to follow these examples or any other alternative approaches to the full guidance.


Systems to manage and monitor the prevention and control of infection. These systems use risk assessments and consider how susceptible service users are and any risks that their environment and other users may pose to them.

In a small service providing personal care or accommodation with personal care:

•�Someone with appropriate knowledge and skills will become the IPC Lead and take responsibility for infection prevention and control. This could be the registered provider, registered manager or another member of staff.

•�Infection prevention and control programmes and infrastructures will not need to be as complex as in a larger adult social care or health setting. As a minimum the infection control programme should say what:

− infection prevention and control measures are needed in the service; − policies, procedures and guidance are needed, and how they will be kept

up to date and monitored to make sure they are followed; and − initial and ongoing training staff will receive.

The infrastructure should include:

•�a record of the names and contact details of health practitioners who can provide advice. General Practitioners and the local primary care trust ICT are likely to be key contacts in the infrastructure; and

•�guidance for staff about the type of circumstances in which contact should be made. 46

Appendix A

The annual statement, for anyone who wishes to see it, including residents and regulatory authorities, will not need to be as detailed as one prepared for a health setting. The IPC Lead will ensure their annual statement for each facility provides a short review of any:

•�known outbreaks of infection;

•�audits undertaken and subsequent actions;

•�action taken following an outbreak of infection;

•�risk assessments undertaken for prevention and control of infection;

•�training received by staff; and

•�review and update of policies, procedures and guidance.


Provide and maintain a clean and appropriate environment in managed premises that facilitates the prevention and control of infections.

Domiciliary care services that provide support in people’s own homes will not be expected to comply with this criterion.

Care homes aim to provide a place where people feel at home and the arrangements to keep the environment clean must take this into account. All cleaning routines must respect the fact that in care homes a resident’s bedroom and other shared areas may have furniture and other possessions that belong to that individual.

In some small care homes the specific aim will be to support people to be independent and to have choice and control over their daily life, including decisions about the environment in which they live.

In a service where people are generally well and supported to develop independent living skills:

•�detailed cleaning schedules would not be necessary. Cleaning responsibilities and routines should form part of the individual plan of care;

•�there may be a plan for cleaning communal areas which describes individual responsibilities for cleaning;

•�staff should carry out ongoing assessment of the standard of cleanliness and support residents if cleanliness falls short of an acceptable minimum;

•�it is unlikely that the policy on the environment will need to cover all the points set out in the main guidance; and

47

The Health and Social Care Act 2008 Code of Practice on the prevention and control of infections

•�the decontamination policy is effectively a policy on how to clean all areas of the environment, fixtures and fittings (and medical devices if used) and what products to use. It will not need to be as complex as one in a healthcare setting. Where service users are responsible for cleaning their own rooms, this does not need to be included, although it could be part of their indivi

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