policy and procedure practice manual€¦ · web viewafter each use, our practice team will...

Chapter five: Physical factors

Information contained in this manual is current at November 2014

1 Policy and Procedure Practice Manual I [Type the company name]

The following template policies and procedures are based on the requirements of the

RACGP Standards for General Practices (4th Edition)

TABLE OF CONTENTS1. PRACTICE FACILITIES (CRITERION 5.1.1)..............................................................11.1 Design and layout........................................................................................................11.1.1 Waiting room................................................................................................................21.1.2 Toilets and hand washing facilities...............................................................................21.1.3 Height adjustable beds.................................................................................................31.1.4 Children’s area.............................................................................................................4

2. PHYSICAL CONDITIONS - CONFIDENTIALITY AND PRIVACY (CRITERION 5.1.2)52.1 Visual privacy...............................................................................................................52.2 Auditory privacy............................................................................................................52.3 Protection of health information...................................................................................53. PHYSICAL ACCESS (CRITERION 5.1.3)...................................................................63.1 Physical access to our practice....................................................................................63.2 Disability access...........................................................................................................63.3 Accessible parking.......................................................................................................73.4 Signage........................................................................................................................74. PRACTICE EQUIPMENT (CRITERION 5.2.1)............................................................84.1 Range of equipment.....................................................................................................84.1.1 All equipment must be in good working order............................................................104.1.2 Automated external defibrillator.................................................................................104.1.3 Electrocardiograph and spirometer............................................................................104.1.4 Pulse oximeters..........................................................................................................11

4.2 Hazardous materials..................................................................................................125. DOCTOR’S BAG (CRITERION 5.2.2).......................................................................135.1 Storage.......................................................................................................................135.2 Pharmaceutical benefits scheme emergency drugs for the doctor’s bag..................135.3 Equipping the doctor’s bag for use............................................................................146. SAFETY AND QUALITY USE OF MEDICINES (CRITERION 5.3.1)........................156.1 Computer generated prescriptions.............................................................................156.2 Stolen or lost prescription pads..................................................................................156.3 Providing consumer medicines information...............................................................166.4 Schedule 4 (restricted) and Schedule 8 (controlled) drugs........................................176.5 Use of controlled drugs in our practice......................................................................186.5.1 Controlled drug records..............................................................................................196.5.2 Destroying drugs of addiction.....................................................................................196.5.3 Forms and resources for prescribers.........................................................................206.5.4 Treatment of drug dependant persons.......................................................................206.5.5 Lengthy treatment with a controlled drug...................................................................21

6.6 Restricted and controlled drug storage......................................................................226.7 Storage of medicines (Schedule 2 or 3) and medical consumables..........................236.8 Poisons permit – for Schedule 4 drugs (restricted)....................................................246.9 Poisons permit – for Schedule 8 drugs (controlled)...................................................256.10 Expiry dates...............................................................................................................26

6.10.1 The highlighter method..............................................................................................267. VACCINE POTENCY (CRITERION 5.3.2)................................................................277.1 National vaccine storage guidelines..........................................................................277.1.1 Vaccine maintenance and monitoring responsibility..................................................277.1.2 Vaccine delivery.........................................................................................................277.1.3 Vaccine storage.........................................................................................................287.1.4 Vaccine temperature monitoring................................................................................297.1.5 Vaccine fridge maintenance.......................................................................................297.1.6 Packing a vaccine refrigerator....................................................................................307.1.7 Monitoring the cold chain process.............................................................................307.1.8 Maintenance of the vaccine fridge.............................................................................317.1.9 Delivery of vaccines...................................................................................................317.1.10 Transport of vaccines.................................................................................................317.1.11 Refrigerator power failures.........................................................................................317.1.12 Cold chain failure.......................................................................................................32

7.2 Maintenance of medical supplies...............................................................................337.2.1 Medical supplies logbook...........................................................................................33

8. HEALTHCARE ASSOCIATED INFECTIONS (CRITERION 5.3.3)............................348.1 Infection prevention and control principles.................................................................348.2 Definitions..................................................................................................................358.3 Allocation of responsibility..........................................................................................368.4 Standard precautions.................................................................................................378.5 Transmission based precautions...............................................................................388.5.1 Contact precautions...................................................................................................398.5.2 Droplet precautions....................................................................................................408.5.3 Airborne precautions..................................................................................................41

8.6 Use of personal protective equipment.......................................................................428.6.1 Removal and disposal of personal protective equipment..........................................43

8.7 Methods of hand hygiene...........................................................................................448.8 Fingernails and jewellery............................................................................................458.9 Safe sharps management..........................................................................................488.10 Use, removal and disposal of sharps containers.......................................................498.11 Single use equipment.................................................................................................508.12 Reusable medical equipment.....................................................................................518.12.1 Use of reusable medical equipment...........................................................................528.12.2 Manual cleaning of reusable medical equipment.......................................................54

8.13 Equipment processing area.......................................................................................558.13.1 Sinks..........................................................................................................................558.13.2 Bench tops.................................................................................................................568.13.3 Suggested processing area design and layout..........................................................56

8.14 Sterilisation.................................................................................................................578.14.1 Sterilisation by steam under pressure........................................................................578.14.2 Sterile barrier systems...............................................................................................58

8.14.3 Packaging reusable medical devices.........................................................................598.14.4 Labelling.....................................................................................................................608.14.5 Loading the steriliser..................................................................................................618.14.6 Processing time..........................................................................................................628.14.7 Monitoring of the sterilisation process........................................................................638.14.8 Unloading the steriliser...............................................................................................648.14.9 Storage of sterilised equipment.................................................................................658.14.10 Documenting the cycle...............................................................................................668.14.11 Validation of the sterilisation process.........................................................................678.14.12 Conducting validation.................................................................................................68

8.15 Safe handling of pathology specimens......................................................................698.16 Skin integrity...............................................................................................................698.17 Medication administration..........................................................................................698.18 Management of blood and body fluid exposure.........................................................708.19 Spills Kit.....................................................................................................................708.20 Method for cleaning spills...........................................................................................718.21 Laundry......................................................................................................................728.21.1 How often to change linen..........................................................................................728.21.2 Handling, changing, sorting and separation of used linen.........................................738.21.3 Cleaning linen............................................................................................................73

8.22 Management and disposal of waste..........................................................................758.22.1 Segregation................................................................................................................758.22.2 Cytotoxic waste..........................................................................................................758.22.3 Clinical (controlled) waste..........................................................................................768.22.4 General waste............................................................................................................768.22.5 Pharmaceutical waste................................................................................................778.22.6 Waste storage............................................................................................................778.22.7 Moving waste.............................................................................................................788.22.8 Waste disposal...........................................................................................................788.22.9 Minimising waste production......................................................................................79

8.23 Environmental cleaning..............................................................................................808.23.1 Scheduled cleaning....................................................................................................808.23.2 Example of a cleaning schedule................................................................................828.23.3 Cleaning products......................................................................................................838.23.4 Hazardous substances...............................................................................................848.23.5 Carpet........................................................................................................................858.23.6 General purpose areas – spot cleaning.....................................................................858.23.7 Treatment rooms – large spills...................................................................................85


1. PRACTICE FACILITIES (CRITERION 5.1.1)

Policy

Our practice facilities are appropriate for a safe and effective environment for patients and the practice team.

1.1 Design and layoutOur practice has at least one dedicated consulting/examination room for every member of our clinical team working in our practice at any time.

Each of our consultation rooms:

Is free from excessive noise.

Has adequate lighting.

Has an examination couch.

Is maintained at a comfortable ambient temperature.

Ensures patient privacy when the patient needs to undress for a clinical examination (eg by the use of adequate curtains or screens and gowns or sheets).

Rooms are assigned as follows:

Room 1 Room 2 Room 3 Room 4

Monday Dr Jones Dr Smith Dr Davies Dr Black

Tuesday Dr Jones Dr Smith Dr White Dr Black

Wednesday

Thursday

Friday

Saturday

Sunday

Information contained in this manual is current at February 2015

Policy and Procedure Practice Manual I [Type the company name] 1


1.1.1 Waiting roomOur practice waiting area is sufficient to accommodate the usual number of patients and other people who would be waiting at any given time.

Our patient waiting area will be kept clean and tidy and will provide appropriate security for staff, patients and visitors.

Our reception staff are required to maintain the tidiness of the waiting area including:

Straightening of books and magazines at the break of each session or as required.

Aligning chairs.

Ensuring health promotion brochures and pamphlets are tidy and on display.

Reporting any spills (bodily fluids such as vomit or urine) to the practice nurse or designated person for cleaning.

Vacuuming if required (such as leaf litter or sand build up from shoes or wind).

1.1.2 Toilets and hand washing facilitiesOur practice has toilets and hand washing facilities readily accessible for use by both patients and staff.

Washbasins are situated in close proximity to the toilets to minimise the possible spread of infection are easily accessible to general practitioners, other staff and patients.

Our staff toilets and basins are located<<location of bathroom/s>>.

Our patient toilets and basins are located <<location of bathroom/s>>.

Liquid hand soap and paper hand towels will be kept stocked and available in the staff and patient hand washing areas.

The bins will be emptied daily by the cleaner/practice staff and disposed of as general waste.




1.1.3 Height adjustable beds Height adjustable beds are especially necessary for patients with limited mobility. As such, our practice has one (or more) height adjustable beds in patient consultation areas.

Our practice’s height adjustable bed(s) are located <<location of height adjustable bed/s>>.

Height adjustable beds may assist our team to:

Reduce the risks associated with patients getting on and off the examination couch, especially for people with impaired mobility.

Reduce the risk of misdiagnosis or non-detection of serious medical conditions through difficulty in conducting an examination if a patient is not able to be examined on a standard examination couch.

Reduce the risk of practice staff injuring themselves when examining patients or assisting patients on and off an examination couch.

Reduce risks associated with the practice’s legal responsibilities under the Disability Discrimination Act to ensure equal access for people with disability to the same range and quality of medical care as others.

Height adjustable beds will be lowered to assist patients with impaired mobility on to and off the examination bed.

Insert instructions from height adjustable bed manufacturer for use protecting staff and patients from occupational health and safety hazards




1.1.4 Children’s areaOur practice waiting area has a section kept as a children’s play area.

Children will not be left unattended by their parents and any staff noticing an unattended child will seek the attention of their parent.

When purchasing toys for our children’s play area, consideration will be given to the ability to easily clean the toy. Preferred toys and games are:

Age appropriate and safe

Made of non-porous material such as plastic or intact lacquered wood and easily dissembled for cleaning,

Large jigsaw puzzle pieces

Building blocks

Plastic paged books that can be wiped down

Our children’s toys and games will be kept in a safe and clean condition. Damaged or potentially dangerous/choke hazardous toys will not be made available.

Second hand toys will not be accepted for use in our children’s play area.

Stuffed or cloth toys will not be used.

Disposable toys will also be considered such as colouring in sheets and crayons.

Toys and games pose a risk of cross infection and will be cleaned regularly.

Surface Product Method Frequency

Toys Detergent and water

Clean thoroughly

When visibly soiled

Immediately after use if young children are observed ‘mouthing’ toys

Otherwise, monthly

For more information please see policies on:

Physical factors, Chapter 8.20 - Environmental cleaning

Source: Infection control standards for office based practices: (5th edition). Royal Australian College of General Practitioners. Melbourne, 2014




2. PHYSICAL CONDITIONS - CONFIDENTIALITY AND PRIVACY (CRITERION 5.1.2)

The physical conditions in our practice support patient privacy and confidentiality.

2.1 Visual privacyVisual privacy will be provided to patients during any clinical examination by the use of a gown or sheet and an adequate curtain or screen.

Members of our clinical team will be sensitive to patient dignity when patients are required to undress/dress in the presence of the medical practitioner or practice nurse.

Patients may request a chaperone in some circumstances.


Rights and needs of patients, Chapter 4 - Presence of a third party

2.2 Auditory privacyWhere possible, consultations should not be able to be overheard by others. Private conversations will not be held in the patient waiting area or any other public space within the practice.

Our practice has background music or a television playing in the waiting room to mask conversations between staff members and between staff and patients. In areas of the practice such as nurses’ treatment bays where auditory privacy is not possible, patients will be offered a private room for conversation as required.

Our consultation room doors are solid (rather than doors with paper cores). Draught proofing tape may be affixed around door frames and a draught excluder may be placed at the base of the door when necessary.

2.3 Protection of health informationIt is important that patients have confidence their health information is being treated respectfully and with consideration to privacy and confidentiality. Privacy and confidentiality of patient information needs to be considered in all situations including discussions between staff members and telephone conversations between staff and patients.

Patient records and computer screens will be positioned so that confidential information is not visible to anybody but the appropriate members of the practice team. Timed screen savers and automatic log out after 2/5 minutes of non-use are installed on all computers.




3. PHYSICAL ACCESS (CRITERION 5.1.3)

Our practice provides appropriate physical access to our premises and services including access for people with disabilities or special needs.

3.1 Physical access to our practiceOur practice provides access to patients, visitors and staff via the main entrance at the front of the site <and other access points>.

All staff will monitor the main entrance and are responsible for keeping the area clean. tidy and clutter free.

3.2 Disability accessOur practice will ensure fair and equitable access for patients and visitors with a disability.

Our practice has installed disability access to our buildings and facilities for people with a disability.

Wheelchair access is provided via <location of wheelchair access> to reception, toilets and consulting rooms.

Home visits, where safe and reasonable, are available for patients who cannot physically access the practice and its facilities.

Additional resources:

A brief guide to the Disability Discrimination Act. The Australian Human Rights Commission. http://www.humanrights.gov.au/our-work/disability-rights/guides/brief-guide-disability-discrimination-act

Access to health services for people with disabilities. The Australian Human Rights Commission https://www.humanrights.gov.au/access-health-services-people-disabilities



https://www.humanrights.gov.au/access-health-services-people-disabilities

http://www.humanrights.gov.au/our-work/disability-rights/guides/brief-guide-disability-discrimination-act

http://www.humanrights.gov.au/our-work/disability-rights/guides/brief-guide-disability-discrimination-act


3.3 Accessible parkingOur practice car parking is well lit and accessible for patients with a disability and available for patients and staff at <location of car parking>.

Automatic sensor lights and evening lights come on at 6/7 pm each day to keep our parking area well lit.

3.4 SignageThere are prominent signs promoting this surgery located at <location of signs>.

The sign displays <”surgery” “doctor” “medical”> and <practice name and phone number>.

At the entrance to the surgery, the sign displays the <practice name, phone number, after-hours phone number, operating hours, the doctors’ names and the nearest hospital location(s)>.

The practice manager will update the external practice signage in times of extended closure such as Easter and Christmas holidays to advise of the emergency facilities and alternative options for care.




4. PRACTICE EQUIPMENT (CRITERION 5.2.1)

Policy

Our practice has access to the medical equipment necessary for comprehensive primary care including emergency resuscitation.

4.1 Range of equipmentOur medical practitioners have access to equipment for comprehensive primary care and emergency resuscitation including:

Auriscope.

Blood glucose monitoring equipment.

Disposable syringes and needles.

Equipment for resuscitation, equipment for maintaining an airway (for children and adults), equipment to assist ventilation (including bag and mask), iv access, and emergency medicines.

Examination light.

Eye examination.

Gloves (sterile and non-sterile).

Height measurement device.

Measuring tape.

Monofilament for sensation testing.

Ophthalmoscope.

Oxygen cylinder, tubing and mask.

Patella hammer.

Peak flow meter.

Pulse oximeters.

Scales.

Spacer for inhaler.

Specimen collection equipment.

Sphygmomanometer with small, medium and large cuffs.

Stethoscope.

Surgical masks.

Thermometer.

Torch.

Tourniquet.

Urine testing strips.

Vaginal specula.

Visual acuity charts.




X-ray viewing facilities.

It is the responsibility of the user of the equipment to report any fault or breakage to the practice manager for repair or replacement.

The practice nurse is responsible for the general maintenance of clinical equipment including stock take and order of consumables and will ensure a set of items for regular use are available in each doctor’s room.




4.1.1 All equipment must be in good working orderOur practice team maintain all equipment to a good working order.

Equipment that requires calibration or that is electrically or battery powered (eg electrocardiographs, spirometers, autoclaves, vaccine refrigerators, scales or defibrillators) are serviced on a regular basis in accordance with the manufacturer’s instructions to ensure it is maintained in good working order.

Our practice maintains a register of equipment in the practice which includes the schedule for servicing or maintenance.

The equipment register is located <location of equipment register>.

4.1.2 Automated external defibrillator Select the most appropriate option for your practice, or create your own procedure

<<Option 1>>

Our practice has an automated external defibrillator (AED) in view of the significant improvement in patient outcomes achieved by early defibrillation.

All staff are appropriately trained to use this equipment.

The AED is located <location of AED>.

<<Option 2>>

Our practice does not have an automated external defibrillator (AED).

4.1.3 Electrocardiograph and spirometerSelect the most appropriate option for your practice, or create your own procedure

<<Option 1>>

Our practice has an electrocardiograph (ECG) and a spirometer onsite.

Our medical practitioners and nursing staff are appropriately trained to use and maintain the equipment and analyse results.

The ECG and spirometer are located <location of ECG and spirometer>.

<<Option 2>>

Our practice does not have an electrocardiograph (ECG) and a spirometer onsite. However we have timely access for emergency use from <facility / location of ECG and spirometer>.




4.1.4 Pulse oximetersSelect the most appropriate option for your practice, or create your own procedure

<<Option 1>>

Our practice has a pulse oximeters(s) onsite.

Our medical practitioners and nursing staff are appropriately trained to use and maintain the equipment and analyse results.

The pulse oximeters are located <location of pulse oximeters >.

<<Option 2>>

Our practice does not have pulse oximeters onsite. However we have timely access for emergency use from <facility / location of pulse oximeters >.




4.2 Hazardous materialsAll hazardous materials, including liquid nitrogen and oxygen will be stored securely and in accordance with manufacturer’s instructions.

As required by the Occupational Safety and Health Regulations 1996 and the National Code of Practice for the Preparation of Material Safety Data Sheets, any hazardous substance used or stored at this practice will have a corresponding Material Safety Data Sheet (MSDS). The MSDS provides information about the ‘hazardous substance’ and how it should be used and how to avoid harm when using it at the workplace.

Any staff member required to handle chemicals are trained in their correct and safe use. This includes the correct use of personal protective equipment (PPE).

This practice has a register which lists all hazardous substances used in this workplace with a current MSDS for each of the substances listed.

MSDS are written in English and contain the following information:

The identity of the chemical,

Health and physicochemical hazards,

Safe handling and storage procedures,

Emergency procedures, and

Disposal considerations.

All chemicals are stored in an area not accessible to the public.


Physical factors, Chapter 7 - Vaccine potency Physical factors, Chapter 8.20 - Environmental cleaning Physical factors, Chapter 8 - Healthcare associated infections

Sources:

Hazardous substances. Western Australian Government Department of Mines, Industry Regulation and Safety https://www.commerce.wa.gov.au/worksafe/hazardous-substances

Safety Data Sheets. Safe Work Australia. http://www.safeworkaustralia.gov.au/sites/swa/whs-information/hazardous-chemicals/sds/pages/sds



http://www.safeworkaustralia.gov.au/sites/swa/whs-information/hazardous-chemicals/sds/pages/sds


https://www.commerce.wa.gov.au/worksafe/hazardous-substances%20


5. DOCTOR’S BAG (CRITERION 5.2.2)

Policy

Our practice ensures that each general practitioner has access to a doctor’s bag.

5.1 StorageThe intention of doctor’s bag supplies is that they are in the personal possession of the doctor for use when attending patients at places other than their usual place of practice.

Medical practitioners are responsible for ensuring these supplies are not accessed by unauthorised persons.

Storage of doctor’s bag medicines in vehicles is not acceptable. If the doctor’s bag medicines are stored in the surgery overnight, they must be locked up in the same way as other Schedule 4 and 8 medicines.

If a medical practitioner obtains Schedule 8 medicines, as part of the Pharmaceutical Benefits ‘Doctors Bag’ supply, these cannot be amalgamated with supplies from other practitioners in the practice, or with supplies of Schedule 8 medicines obtained through a Poisons Permit.

Our doctors store their doctor’s bags Location of doctor’s bags

5.2 Pharmaceutical benefits scheme emergency drugs for the doctor’s bagThe Australian Government Department of Health Pharmaceutical Benefits Scheme (PBS) provides certain pharmaceuticals without charge to prescribers who in turn can supply them free of charge to patients for emergency use. This is referred to as the Prescriber Bag (emergency drug supply).

The prescriber bag supply order form <CONTACT THE PHARMACY FOR A COPY> must be completed in triplicate, signed and the original and duplicate given to a pharmacist. Each form is valid for the month indicated on the form.

Prescribers may order the maximum quantity of an item provided they do not already have the maximum quantity on hand. The items can only be obtained once a month. Prescribers may also ask for a particular brand of a pharmaceutical benefit. If it is unavailable, they must specify another listed brand, and initial the alteration.

A receipt must be signed by the prescriber, or by an authorised representative, when supplies are received.

The <person responsible for maintaining doctor’s bag> will conduct a regular review of the contents of the doctor’s bag.

For shared information about this procedure, see:

Physical factors, Chapter 7.2 - Maintenance of medical supplies




5.3 Equipping the doctor’s bag for useEach of our doctors has access to a fully equipped doctor’s bag. It contains equipment, drugs and stationery for diagnosis and treatment of common and urgent problems. The contents are kept at optimum levels with expired drugs discarded and replaced with current items.

The following supplies are included as a minimum in every doctor’s bag:

Auriscope.

Disposable gloves.

Equipment for maintaining an airway in both adults and children.

'In date' drugs for medical emergencies.

Ophthalmoscope.

Pathology collection containers eg bloods, urine specimen jars.

Practice stationery including prescription pads and letterhead.

Sharps container.

Sphygmomanometer.

Stethoscope.

Syringes and needles in a range of sizes.

Thermometer.

Tongue depressors.

Torch.

The <person responsible for maintaining doctor’s bag> will conduct a regular review of the contents of the doctor’s bag.

For shared information about this procedure, see:

Physical factors, Chapter 7.2 - Maintenance of medical supplies




6. SAFETY AND QUALITY USE OF MEDICINES (CRITERION 5.3.1)

Policy

Our clinical team prescribes, dispenses and administers appropriate medicines safely to informed patients.

Our clinical team will ensure that medicines (including samples and consumables) are acquired, stored, supplied and disposed of in accordance with the manufacturer’s instructions and jurisdictional requirements.

6.1 Computer generated prescriptionsSelect the most appropriate option for your practice, or create your own procedure

<<Option 1>>

Our practice software does not have the capacity to generate computer printed prescriptions.

<<Option 2>>

Our practice software includes the capacity to generate computer printed prescriptions.

Access to this level requires a password for access. Practice staff other than prescribers must not be given an access level that would allow them to generate a prescription. Passwords must not be divulged to other staff.

The Poisons legislation requires that certain elements on computer printed prescriptions for Schedule 8 medicines must also be handwritten. This provision is intended to increase the chance that a forgery will be detected by the dispensing pharmacist. The prescriber must handwrite the name and strength of the Schedule 8 medicine, the directions for use (including dose and frequency), the quantity to be supplied, the number of repeats (if any) and the repeat interval. For Pharmaceutical Benefit Scheme (PBS) prescriptions, these handwritten elements must be added to both the original prescription and the duplicate.


Practice Management, Chapter 4.2 - Responsibility based access

6.2 Stolen or lost prescription padsPrescription pads and prescription computer stationery are sought after items by those intending to forge prescriptions, primarily to access Schedule 8 medicines. Our doctors will store these items out of sight and in an area inaccessible to the public.

If a prescription pad or other prescription stationery is stolen, the Western Australian (WA) Police and the Pharmaceutical Services Branch will be notified. The Pharmaceutical Services Branch will issue an alert to all pharmacies in WA about stolen prescription stationery in an attempt to reduce the chance of any forgeries being acted on.




6.3 Providing consumer medicines information Our medical practitioners will encourage patients to read consumer medicines information (CMI) for all new medications, including S4 and S8 drugs.

This information is available:

Within medication packaging.

Online produced by pharmaceutical companies.

Pharmacies.

Download from our practice software.

CMI is also available in pictorial media for those who cannot understand written language and in other languages.

Discussions will include:

Possible side effects or risks.

Interactions with other medications.

The difference between generic and brand name medicines.

Medication management.

The rationale for taking medicines.

The benefits.

A treatment plan.

More information for patients and professionals is available at https://www.nps.org.au/



https://www.nps.org.au/


6.4 Schedule 4 (restricted) and Schedule 8 (controlled) drugsControlled and restricted drugs (and some poisons) cannot be prescribed, dispensed, obtained or possessed by a doctor unless he or she is a specialist in a particular field, or unless he or she has the written approval of the Chief Executive Officer at the Western Australian Department of Health. These items must be stored, documented, administered and disposed of in line with the requirements of legislation mandated by each state.

Definitions

The differences between controlled and restricted drugs are:

Schedule Description

Controlled Drugs(Schedule 8)

Regulated controlled drugs are Schedule 8 substances that have additional restrictions placed upon them due to their nature and potential toxicity. They are prescription only medications, which are mainly used for strong pain relief. The supply and use of these drugs is restricted because of their dependence-forming nature and potential for abuse.

Restricted Drugs(Schedule 4)

Regulated restricted drugs are Schedule 4 substances that are dependence-forming and subject to abuse. They are medications that are available on prescription only. They are not as regulated as controlled drugs, but their supply is mainly restricted to doctors, dentists and veterinary surgeons because their use requires professional management and monitoring.




6.5 Use of controlled drugs in our practiceSelect the most appropriate option for your practice, or create your own procedure

<Option 1>

This practice believes that having Schedule 8 drugs on the premises or in doctors’ bags provides an unacceptable risk to staff. It is therefore the policy of this practice that no Schedule 8 drugs are kept on the premises. There are signs to this effect posted at points external and internal to the practice. If any person should notice or become aware of Schedule 8 drugs being present in the practice they must immediately notify the practice manager. Doctors in this practice utilise prescriptions and the local pharmacy to access these drugs when required.

<Option 2>

This practice believes that having Schedule 8 drugs kept in general storage areas provides an unacceptable risk to staff. It is therefore the policy of this practice that all Schedule 8 drugs are to be kept in the personal possession of the doctor. The doctor is solely responsible for the safe, secure and legal storage of these drugs. The doctor is responsible for all documentation of their acquisition and usage. If staff see any of these drugs not securely stored, they must immediately notify the practice manager.

<Option 3>

The nature of this practice, and the preferences of the medical staff, requires Schedule 8 drugs to be kept on the premises and in the doctor’s bags, and be readily available to all medical staff, including locums under the conditions of the Poisons Permit and the Poisons Act 1964. Individual medical practitioners may apply for a Poisons Permit from the Chief Executive at the Western Australian Department of Health. The medical practitioner holding the Poison’s Permit will be responsible for the storage, documentation of use, disposal and destruction and renewal or cancellation of the Poisons Permit.




6.5.1 Controlled drug records The individual medical practitioner is required to record the purchase, use and disposal of Schedule 8 drugs which is to be kept in a book in compliance with Regulation 46. Each entry in this book is to include the following particulars and must be recorded in ink:

The name of the drug;

The quantity obtained, administered, used or disposed of;

The name of the patient being administered the drug or how the drug was used or disposed of; and

The date and the quantity of drug remaining on hand.

Each entry must be signed by the medical practitioner at the time of drug use.

No entry in the record book may be altered unless an error is to be corrected. Each correction must only be made by a marginal note or footnote which provides the date of the correction and the correct particulars.

All records documenting the purchase and use of Schedule 8 drugs are to be kept for a period of 7 years and must be available to officers authorised under the Poisons Act upon request.

6.5.2 Destroying drugs of addiction Our practice will dispose of unwanted and out of date controlled medicines as per the Poisons Regulations 1965.

Schedule 8 medicines may only be destroyed by:

A medical practitioner and a director of nursing

A medical practitioner and a pharmacist

A pharmacist and a director of nursing or

Two pharmacists.

One of these people must be witness to the other. A record of the destruction must be kept and both people must sign and date the relevant entry in the Schedule 8 Register at the time of the destruction.

Under the Poisons Regulations 1965, a person who destroys poisons included in Schedule 8 must maintain a register of the poisons destroyed and record in it, at the time of each destruction:

The date of destruction; and

The name, strength and quantity of the poison destroyed; and

The reason for the destruction; and

The name of the witness to the destruction: and,

If the register is maintained on paper, is to sign, and cause the witness to sign, that entry in the register.




6.5.3 Forms and resources for prescribersThe Western Australian Department of Health has resources available from their website at www.public.health.wa.gov.au for prescribers such as:

Application to prescribe a Schedule 8 medicine

Notification of a patient with addiction to drugs

Treatment contract for the use of opioid medicine

Application to transfer a Schedule 8 prescription

Ordering form – Managing chronic non-malignant pain with opioids: A resource kit for general practitioners (GPs)

Quick clinical guidelines for the use of opioids in chronic non-malignant pain

A medical practitioner may contact the Western Australian Department of Health on telephone 9388 4985, to check whether a patient has a Schedule 8 authorisation with another doctor or is a registered drug addict.

More information is available at:

http://ww2.health.wa.gov.au/Health-for/Health-professionals

6.5.4 Treatment of drug dependant personsDoctors in this practice will not prescribe, administer, etc. a controlled drug or restricted drug of dependency to or for a person the doctor reasonably believes to be drug dependent without the written approval of the Executive Director of Public Health. A doctor wishing to treat a drug dependent person must report the circumstances of the case to the Executive Director of Public Health.

If approval is granted, the doctor must not administer, prescribe, etc. a controlled drug or a restricted drug of dependency in excess of the quantity approved by the Executive Director of Public Health.

For more information see:

Notification of statutory medical notifications in Western Australia http://ww2.health.wa.gov.au/Articles/A_E/About-statutory-medical-notifications-in-Western-Australia



http://ww2.health.wa.gov.au/Articles/A_E/About-statutory-medical-notifications-in-Western-Australia

http://ww2.health.wa.gov.au/Articles/A_E/About-statutory-medical-notifications-in-Western-Australia

http://ww2.health.wa.gov.au/Health-for/Health-professionals

http://www.public.health.wa.gov.au/


6.5.5 Lengthy treatment with a controlled drug It is the policy of this practice that doctors notify the Chief Executive at the Western Australian Department of Health of any patient who is being or will be treated with a controlled drug for longer than 60 days in any 12 months. The doctor must also notify the Executive Director of Public Health at the Western Australian Department of Health if he/she reasonably suspects that the patient has been treated with a controlled drug for more than two months by another doctor(s), and wishes to continue the treatment of the patient with a controlled drug. Such notification must be in writing, using the approved form.


Our practice, Chapter 3 - Practice Contacts




6.6 Restricted and controlled drug storage Schedule 4 storage

Schedule 4 drugs will be stored at all times in a:

Locked cupboard; or

Locked room; or

Locked fridge; or

In a fridge in a locked room; and

Where only medical staff have access

Schedule 8 storage

All Schedule 8 drugs purchased by a medical practitioner for use in his/her professional practice are to be stored in their personal care, or in an easily identified container in a compliant safe which complies with the Poisons Act and Regulation (Regulation 56(1) & (2)). This does not permit the amalgamation of stock obtained by different medical practitioners into common stock.

Our safe will have:

A cabinet and door made of solid steel at least 10mm thick;

A flush fit door with maximum clearance of 1.5mm when closed;

A dogbolt hinge system for the door;

Welding continuous on all edges locked with 6 lever key or 3 to 4-wheel combination or equivalent electronic combination lock; and is

Mounted to a brick wall or concrete floor.

Recommended reading:

Western Australian Department of Health – Medicines and poisons

http://ww2.health.wa.gov.au/

http://ww2.health.wa.gov.au/Health-for/Health-professionals/Medicines-and-poisons

For details of safe compliance contact the Western Australian Department of Health Pharmaceutical Services Branch on telephone 9222 6883.



http://ww2.health.wa.gov.au/Health-for/Health-professionals/Medicines-and-poisons

http://ww2.health.wa.gov.au/


6.7 Storage of medicines (Schedule 2 or 3) and medical consumables Medicines in Schedules 2 and 3 are medicines which are able to be sold ‘over the counter’ in pharmacies. These medicines may only be supplied to patients by a medical practitioner as part of a consultation. Schedule 2 and 3 medicines cannot be displayed for sale elsewhere in the surgery, such as in the reception area.

Medicines in Schedules 2 and 3 must be stored in a locked cupboard or locked room. Refrigerated items, such as vaccines, must be stored in either a locked refrigerator or a refrigerator in a locked room. Public access to this area will be restricted.

The cupboard or room must only be accessible to the permit holder, medical practitioners and nursing staff. If the room is also accessible to other practice staff such as receptionists and cleaners without supervision, then the medicines must be kept in a locked cupboard within the room.

Medicines must be stored so that contamination of food and drink will not occur.

<Location of Pharmaceuticals and medical consumables>

General storage cupboard

Doctor’s bag

Treatment room

Consulting room

Select the most appropriate option for your practice, or create your own procedure

<Option 1>

This practice has a cupboard for general storage of pharmaceuticals and medical consumables and the cupboard is located <Location of pharmaceuticals and medical consumables storage cupboard>

The cupboard is locked and the key is located <Location of pharmaceuticals and medical consumables storage cupboard key>.

All staff must ensure the cupboard doors are not left open and patients and visitors are not advised of the storage room location. Pharmaceutical representatives are not allowed to restock the pharmaceuticals without practice staff supervision.

<Option 2>

This practice has a separate room for general storage of pharmaceuticals and medical consumables.

The storage room is locked and the key is located <Location of pharmaceuticals and medical consumables storage cupboard key>.

All staff must ensure the storage room doors are not left open and patients and visitors are not advised of the storage room location. Pharmaceutical representatives are not allowed to restock the pharmaceuticals without practice staff supervision.




6.8 Poisons permit – for Schedule 4 drugs (restricted)The holders of a WA Poisons Permit for Schedule 4 drugs at this practice are:

Name Position held Permit number

The holder of a poisons permit is authorised to purchase Schedule 4 drugs on behalf of a clinic or medical centre. The permit holder will be the responsible person for ensuring compliance with the Poisons Regulations and any conditions placed on the poisons permit. They do not need to be a medical practitioner but will be required to be an ‘experienced person’. Generally, this is expected to be a registered nurse.

The permit holder is responsible for the purchase, storage, security and use of the Schedule 4 drugs within the practice. The poisons permit holder is required to develop, implement and maintain suitable systems within the facility which restrict access, ensuring appropriate storage occurs and that records of use are maintained.

Details of this responsibility are included in the poisons permit holder’s position description.

Access to Schedule 4 drugs are limited to authorised personnel, including the permit holder or a nominated deputy when the permit holder is unavailable, including medical practitioners and registered nurses. Schedule 4 drugs may only be stored in a locked cupboard in a general area, or in an unlocked cupboard in a locked room where access can be controlled and limited to authorised personnel.

Registered nurses are authorised to be in possession of drugs for the purpose of their work and can access and use these drugs under the authority of the medical practitioner.

Usage of all Schedule 4 drugs is to be recorded, either in the patient’s notes or in a book dedicated to the supply of Schedule 4 drugs. Schedule 4 drugs may only be used on the authorisation of a medical practitioner. Any drugs supplied to a patient for use outside of the facility must be labelled in accordance with the Poisons Regulations, be authorised by a medical practitioner, preferably in writing and checked by a medical practitioner.

The Permit holder will be responsible for the administration of all medicines on the sites listed and for compliance with the ‘Code of Practice for holders of a Health Services Poisons Permit for Medical Treatment’.




6.9 Poisons permit – for Schedule 8 drugs (controlled)The holders of a WA Poisons Permit for Schedule 8 drugs at this practice are:

Name Position held Permit number

Individual doctors may purchase Schedule 8 drugs for use in their professional practice or a Poisons Permit may be issued under the Poisons Act to enable the medical clinic to purchase the drugs for use at the practice that only medical practitioners and persons authorised in writing by the delegate of Chief Executive Officer of Health (holders of a Poisons Permit) are able to purchase or have access to Schedule 8 drugs.

An individual medical practitioner may order Schedule 8 drugs for use in his/her professional practice at their usual practice address. The medical practitioner is then responsible for the storage and all recording associated with the use of these drugs.

Registered nurses are authorised to be in possession of drugs for the purpose of their work and can access and use these drugs under the authority of the medical practitioner.

Details of this responsibility are included in the poisons permit holder’s position description.

Members of the public and office staff are not permitted to have access to Schedule 8 drugs.

All administration or supply of Schedule 8 drugs to patients must be recorded in a Drugs of Addiction Register approved by the Chief Executive Officer of Health and in the patient’s notes.

Usually Schedule 8 drugs acquired in this way are administered in an emergency or urgent situation and not for ongoing treatment. All Schedule 8 drugs used for ongoing treatment are subject to the 60-day rule. Authorisation is required from the Western Australian Department of Health if treatment is to extend beyond 60 days.

Patients who have been registered as drug addicts cannot be given a prescription for a Schedule 8 drug unless the medical practitioner at that surgery has been authorised by the Western Australian Department of Health to prescribe Schedule 8 drugs for that patient. Patients who have been registered as drug addicts may only be administered a Schedule 8 drug, as a one-off treatment for medical emergency. A medical practitioner may contact the Western Australian Department of Health on telephone 08 93884 985, to check whether a patient has an authorisation with another doctor or is a registered drug addict.

All records documenting the purchase and use of Schedule 8 drugs are to be kept for a period of 7 years and must be available to officers authorised under the Poisons Act upon request.

The Permit holder will be responsible for the administration of all medicines on the sites listed and for compliance with the ‘Code of Practice for holders of a Health Services Poisons Permit for Medical Treatment’.




6.10 Expiry datesPerishable medical supplies including vaccines and pharmaceutical consumables are routinely checked to ensure potency.

It is the responsibility of the <position responsible for maintaining medical supplies> to check medical supplies on a <frequency of expiry date review> basis.

The <position responsible for maintaining medical supplies> clearly labels all new medical consumables with the expiry date using a black marker pen or the ‘highlighter method’. Items with the closest ‘use by date’ are placed nearest to the front of the shelf or drawer.

Any items that are due to expire within the <frequency of expiry date review> period are <discarded / given to the nearby pharmacy which is called . . .>.

It is the responsibility of all medical, non-medical and administrative staff to check the expiry date prior to using the product.

Pharmaceuticals and medical supplies are stored in:

<Location of Pharmaceuticals and medical consumables>

Consider:

General storage cupboard.

Doctor’s bag.

Treatment room.

Consulting room.

Vaccine fridge.

6.10.1 The highlighter methodThis method identifies consumables due for disposal by year due using easy to see, brightly coloured markers:

1. Purchase a set of multiple coloured highlighter marker pens.

2. Keep a chart allocating the years to come with a colour of highlighter marker pen.

(ie 2014 = yellow; 2015 = green; 2016 = blue; 2017 = pink)

3. As new medical consumables are received, mark the packaging clearly with the colour associated with the disposal year and place items with the closest ‘use by date’ nearest to the front of the shelf or drawer.




7. VACCINE POTENCY (CRITERION 5.3.2)

Policy

Our practice maintains the potency of vaccines.

7.1 National vaccine storage guidelinesIt is the policy of this practice that all substances, consumables, drugs and vaccines are to be maintained in surroundings or conditions that will ensure optimal efficacy upon delivery to consumers. Consumables are stored in a manner that minimises risk or hazards to patients and visitors as many substances used in this practice are toxic or harmful if swallowed.

Our practice will at all times maintain the ‘cold chain’ system of transporting and storing vaccines within the safe temperature range of between 2oC – 8oC, preferably stabilising at 5oC. Vaccines are delicate biological products and if not stored appropriately will become ineffective.

It is the responsibility of <position responsible for maintaining medical supplies>

7.1.1 Vaccine maintenance and monitoring responsibilityThere is a nominated staff member with primary responsibility of our vaccines and the monitoring and maintenance of the vaccine fridge.

There is an alternative staff member responsible for the vaccines and the vaccine fridge when the nominated person is away from the practice, or no longer works there.

These staff members have this role defined in their position description and will comply with the current edition of the National Vaccine Storage Guidelines.

7.1.2 Vaccine deliveryOur practice will have a defined process for the ordering, maintenance and receipt of vaccines.

Freezer blocks are checked for ice when vaccines are delivered. If completely thawed, vaccines have not been kept sufficiently cold and may not be effective.

Expiry dates of stock are checked with each delivery.

Vaccines are transferred to the fridge immediately upon delivery.

Vaccines are stored in the fridge in their original packaging. Removal from original packaging exposes vaccines to room temperature and/or lighting.




7.1.3 Vaccine storage Vaccines will be stored in a dedicated vaccine refrigerator. Food and drink will not be stored in

vaccine refrigerators. The National Vaccine Storage Guidelines advise against using bar refrigerators or cyclic defrost domestic refrigerators as they are not suitable for vaccines.

The vaccine fridge door opening will be kept to a minimum.

There is a sticker on the fridge door near the handle instructing staff to consider whether or not they need to open it.

Vaccines are stored on middle and upper shelves. Lower shelves, drawers and door of fridge become too warm (above 10oC) if the fridge is opened frequently.

Maintain a space between vaccine packages and the evaporation plate to prevent the vaccines from freezing through contact with the plate, eg open-weave plastic container.

Vaccines are stored with earlier expiry dates to front. This will ensure that stock is rotated regularly.

Expired vaccines are discarded immediately upon expiry and recorded on the Vaccination Record Form. Always contact the Western Australian Department of Health before discarding any government vaccines. Other vaccines should be discarded in the hazardous waste bin or taken to a pharmacy for disposal.

Gaps are left around the vaccines to allow the cool air to circulate. A gap of at least 4cm from all walls and between large packages of vaccine vials is recommended.

The lower drawers and doors are filled with bottles of salt water. Salt water bottles help stabilise the temperature in the vaccine fridge. Add enough salt to make water undrinkable (approx. 1-2 tablespoons of salt per litre of water). Allow space between the bottles for air circulation.

The salt water bottles are labelled accordingly.

The vaccine fridge is not over filled to ensure that air is permitted to circulate around the vaccines.

There is a practice protocol to follow if vaccines have been exposed to temperatures outside the recommended 2oC – 8oC range. In this situation, it is recommended to keep vaccines refrigerated and contact the Western Australian Department of Health for advice.




7.1.4 Vaccine temperature monitoring The vaccine fridge has a minimum/maximum digital-type thermometer.

The thermometer probe is in a vaccine box labelled “thermometer”, next to a vaccine vial and placed in a plastic perforated basket on the middle shelf of the fridge. This allows the probe to measure the air temperature closest to a vaccine vial.

The vaccine fridge thermometer minimum and maximum temperature is recorded everyday (preferably at the beginning of the first session) in the vaccine fridge logbook.

The vaccine fridge temperature is maintained at 5oC but not less than 2oC and not greater than 8oC.

An adhesive sticker has been placed over the dial instructing staff that only an authorised person is able to modify the temperature.

Our practice will regularly audit our vaccine fridge to ensure the potency of vaccines.

See the National Vaccine Storage Guidelines: Strive for 5 self-audit examples for more information http://www.immunise.health.gov.au/internet/immunise/publishing.nsf/Content/59F63C79DAFAFB38CA257B020002C371/$File/strive-for-5-guidelines.pdf

7.1.5 Vaccine fridge maintenance The vaccine fridge is a ‘frost free’ model (but not cyclic or multi-flow defrost) model.

The vaccine refrigerator is large enough to accommodate the vaccines stored in our practice through the year (please take into account busy periods such as the influenza vaccination period).

Vaccines are stored in an alternative fridge or insulated container with freezer blocks when defrosting the vaccine fridge.

The fridge is in an area where it does not receive direct sunlight.

There is a 10cm space around the fridge to allow ventilation.

The vaccine fridge has a secure power source. For example an uninterruptible power supply (UPS) in case of electricity failure.

There is a sticker placed above the power source warning people to not unplug or turn the power off, or the electricity plug is taped to the socket and is switched to the “on” position.



http://www.immunise.health.gov.au/internet/immunise/publishing.nsf/Content/59F63C79DAFAFB38CA257B020002C371/$File/strive-for-5-guidelines.pdf

http://www.immunise.health.gov.au/internet/immunise/publishing.nsf/Content/59F63C79DAFAFB38CA257B020002C371/$File/strive-for-5-guidelines.pdf


7.1.6 Packing a vaccine refrigerator1. Put new stock to the rear and move existing stock forward.

2. Store vaccines with earlier expiry dates at the front.

3. Store emergency drugs on the lower shelves.

4. Store the vaccines in their original packaging from the manufacturer as this helps to protect them from temperature fluctuations and ultraviolet (UV) light.

5. Label containers clearly with names of vaccines.

6. Do not crowd the vaccines by overfilling the shelves. If not using open weave baskets, allow space between containers for air circulation.

7. When storing influenza vaccine, separate and clearly label vaccines for adults and children less than 5 years of age and store them in separate areas of the refrigerator. It is recommended that pictures or a map are used.

8. Ensure privately purchased vaccines are clearly marked and separated from the National Immunisation Program vaccines.

9. For a solid door refrigerator, place a guide on the outside of the refrigerator indicating where each type of vaccine is stored. Place a picture or map of the packed refrigerator on the door.

10. Do not store food and other goods in the refrigerator. This would increase the likelihood of a cold chain breach by:

Overcrowding the vaccines.Increasing the number of door openings.

7.1.7 Monitoring the cold chain process1. At the beginning of the first session, check the thermometer of the vaccine fridge

2. Record the date, time and minimum and maximum temperature on the vaccine fridge logbook.

3. Reset the thermometer.

4. At the end of the last session, check the thermometer of the vaccine fridge

5. Record the date, time and minimum and maximum temperature on the vaccine fridge logbook.

6. Reset the thermometer.

7. If the thermometer indicates that the minimum and/or maximum temperature has exceeded the recommended range, refer to:

Physical factors, Chapter 7.1.12 - Handling refrigerator power failures Physical factors, Chapter 7.1.13- Cold chain failure




7.1.8 Maintenance of the vaccine fridge1. Report breakdowns to the nominated staff member immediately so that repairs can be made.

2. Regularly check refrigerator seals to ensure cold air cannot leak out. If the seals are brittle or torn, arrange for replacement.

3. Ensure the area around the vaccine fridge (including behind and under) is clean and dust free.

4. Arrange for regular maintenance inspections by the manufacturer or local electrician. Inspections may need to occur more frequently as the refrigerator ages.

7.1.9 Delivery of vaccines1. Check consignment immediately.

2. Ensure the freezer blocks in the consignment are still partly frozen on arrival.

3. Check the temperature monitor is included and of a satisfactory temperature.

4. Ensure that the quantities of the vaccines delivered are correct and have not expired.

5. Transfer the vaccines to the fridge immediately.

6. If freezer blocks are completely thawed, do not use the vaccines. Refrigerate them immediately and contact the supplier for advice.

7.1.10 Transport of vaccines1. Pack vaccines in an insulated esky:

Wrap the vaccines and thermometer probe in bubble wrap, and place at the bottom of the esky.Place a polystyrene separator on top of the bubble wrap.Remove freezer blocks from freezer and allow to ‘sweat’ for 5-10 minutes.Place freezer blocks on top of the polystyrene separator.Close lid of esky and seal with tape.

2. Organise for the esky to be transported as soon as possible.

7.1.11 Refrigerator power failures1. During a power failure of 4 hours or less, keep the vaccine fridge door closed.

2. If the power failure lasts for more than 4 hours, store vaccines in an insulated esky:

Wrap the vaccines and thermometer probe in bubble wrap, and place at the bottom of the esky.Place a polystyrene separator on top of the bubble wrap.Remove freezer blocks from freezer and allow to ‘sweat’ for 5-10 minutes.Place freezer blocks on top of the polystyrene separator.Ensure that the esky is packed in such a way that the freezer blocks do not come into direct

contact with the vaccines.Close lid of esky and seal with tape.

3. Monitor the esky to ensure vaccines are stored between 2oC-8oC.

7.1.12 Cold chain failureInformation contained in this manual is current at February 2015



In the event of a known or suspected cold chain failure:

1. Isolate the suspect vaccines in the refrigerator in a labelled container and do not use them until advised otherwise.

2. Fill out the cold chain variance form. See COLD CHAIN VARIANCE FORM for a suggested template.

3. Contact the Communicable Disease Control Directorate (CDCD), Western Australian Department of Health (see Our practice, Chapter 3 - Practice Contacts for details) and alert them to them known or suspected cold chain failure.

4. Follow all instructions provided by CDCD.

5. If requested, fax through the cold chain variance form.

6. Do not discard any vaccine unless directed to do so by CDCD.




7.2 Maintenance of medical suppliesIt is the responsibility of the <position responsible for maintaining medical supplies> to check stock on a <frequency of medical supply review> basis and re-order when supplies are low. This position is also responsible for checking incoming goods. When extra supplies or new items are needed, the request is to be directed to this staff member.

7.2.1 Medical supplies logbookThe <position responsible for maintaining medical supplies> maintains a logbook of all medical consumables and pharmaceuticals. This logbook is stored <location of medical supply logbook>

On a <frequency of medical supply review> basis, the <position responsible for maintaining medical supplies> reviews medical stock using the Medical Supplies Logbook. The review includes recording the following details:

Name of item.

Location.

Expiry date.

Count of the item.

Date checked.

Initials of staff member.

For template forms see:

Templates, forms and checklists, Chapter six – Stocktake and ordering




8. HEALTHCARE ASSOCIATED INFECTIONS (CRITERION 5.3.3)

Policy

Our practice has systems that minimise the risk of healthcare associated infections.

8.1 Infection prevention and control principlesPatients and staff of our general practice are exposed to the risk of infection through minor surgery, physical examinations, diagnostic procedures and the administration of medication.

Infection control principles are derived from the epidemiology of infectious disease transmission, involving the interaction between host, agent and environment. Infection control practises aim to prevent infection transmission by limiting the exposure of susceptible people (hosts) to micro-organisms (agents) that may cause infection.

Infection control measures protect people in health care settings from infection by:

Maximising host defences.

Removing or controlling sources and reservoirs of micro-organisms (the ‘agent’).

Reducing the risk of transmission by promoting an environment where the risk of interaction (eg contact, droplet or airborne) between potentially infectious agents and susceptible people is minimised.

Standard precautions such as hand washing, immunisation, adherence to the principles of asepsis, use of personal protective equipment, and maintenance of a clean, safe environment, form the basis for the prevention and control of infection in health care settings.

To provide guidance and protection to our patients and staff, our practice has policies and procedures for the following:

Safe handling and disposal of sharps.

Safe handling and transport of specimens.

Safe handling and disposal of waste.

Environmental cleaning.

Appropriate cleaning of blood and body substance spills.

Safe handling and cleaning of reusable instruments.

Exposure to blood and body substance spills.

References and resources

Infection prevention and control standards for general practices and other office-based and community-based practices (5th edition). Published May 2014. Royal Australian College of General Practitioners. http://www.racgp.org.au/your-practice/standards/infectioncontrol/



http://www.racgp.org.au/your-practice/standards/infectioncontrol/


8.2 DefinitionsIndicator Description

Biological Indicator A standardised preparation of calibrated bacterial spores on, or in, a carrier, which is packaged in such a manner that the integrity of the inoculated carrier is maintained.

Chemical Indicator Dye which can be impregnated on materials or contained within a device, and which changes colour when subjected to a sterilising process.

Cleaning A process which removes visible soiling and reduces the load of micro-organisms and bio-hazardous material on the surface of an object.

Contamination The introduction of micro-organisms into sterile materials or living tissue, or the presence of an infectious agent on skin, tissue, or articles, solutions and substances.

Disinfection The process of destroying all micro-organisms except bacterial spores.

Holding Time The minimum time at a given temperature that has been established to destroy all micro-organisms.

Penetration Time The time required for every part of a load to reach the selected sterilising temperature after that temperature has been reached in the sterilising chamber.

Risk Categories Instruments do not have to be sterile at all times; this depends on what is being done. However, sterilisation between patients is essential for all medium and high risk procedures.High Risk Instruments, which penetrate the skin, enter a normally sterile body site or come into contact with severely ulcerated mucous membranes. Always use sterile instruments.Medium Risk Instruments in contact with intact mucous membrane. Sterilise between patients. Do not have to be used sterile. For example, a vaginal speculum can be stored in a covered clean place after sterilising.Low risk Instruments used only on intact skin. Use clean decontaminated equipment

Reusable Device A device designated or intended by the manufacturer as suitable for reprocessing and reuse. It is not a device that is designated or intended by the manufacturer for single use only.

Safety Factor The extra time added to the holding time to ensure sterilisation is achieved. It is a precautionary measure and is calculated as 25 per cent of the holding time.

Soil Visible dirt or debris, which may protect, harbour or assist the growth of micro-organisms. Includes organic matter, organic substances, residual soil, inorganic matter, and blood and body substances.

Sterilisation A process intended to destroy or remove all forms of microbial life, including bacterial spores.

Sterilisation Time The total time of the sterilisation stage after the sterilising chamber has reached the sterilising temperature (penetration time plus holding time plus




safety factor).

Standard Precautions Work practices, which require everyone to assume that all blood and body substances are potential sources of infection, independent of perceived risk. Such precautions involve the use of safe work practice and protective barriers.

8.3 Allocation of responsibilityAll members of our practice team – including doctors, other health professionals, practice staff and external contractors (eg cleaners) – are involved in the practice’s infection prevention and control program. Every staff member has a responsibility to protect fellow staff members, patients, members of the public and themselves, from risk of injury and infection at work.

However, our practice has a designated team member who has primary responsibility for the coordination of infection control processes and environmental cleaning. This person is <Name and role of team member>.

The duties of the Infection Control Officer are detailed in addition to their position description.

The Infection Control Officer will

1. Maintain, review and regularly update the practice infection control policies and procedures as required.

2. Ensure there are adequate supplies of, and a range of sterile reprocessed or disposable equipment.

3. Maintain documentary evidence of a validated process for all instruments sterilised off site.

4. Monitor the integrity of the whole sterilisation process including:

a. Validation of the steriliser process; andb. Validation of the steriliser maintenance.

5. Train and educate staff members, including at induction, in the risks of cross infections within our practice (as appropriate) including procedures for:

a. Hand hygiene;b. Use of personal protective equipment (PPE);c. Triage of patients with potential communicable disease;d. Safe storage and disposal of clinical waste including sharps; ande. Managing blood and bodily fluid spills.

6. Ensure our practice is visibly clean.

7. Coordinate the routine cleaning of our practice.

8. Provide educational posters and paraphernalia to patients on respiratory etiquette, hand hygiene and precautionary techniques to prevent the transmission of communicable diseases, such as:

a. ‘Wash your hands’ posters in the bathrooms.b. ‘Cover your mouth when you cough’ posters in the waiting area.c. Posters advising patients to request and to wear a mask if influenza is suspected.




8.4 Standard precautions

Standard precautions and work practises require all staff to assume that all blood and bodily substances are potential sources of infection - independent of perceived risk. This assumption is recommended for the treatment and care of all patients and in the handling of blood and bodily substances.

Blood and bodily substances include:

Blood.

All other body fluids and secretions (excluding sweat).

Non-intact skin.

Mucous membranes.

Dried blood and other body substances.

Standard precautions include:

Good hygiene practices, particularly washing and drying hands before and after patient contact.

The use of personal protective equipment (PPE) which may include gloves, gowns, plastic aprons, masks and eye shields.

The appropriate handling and disposal of sharps and other contaminated or infectious waste.

Respiratory hygiene and cough etiquette.

The use of aseptic techniques.

Environmental controls such as design and maintenance, cleaning and spills management.

Support services such as waste disposal, laundry and cleaning services.

Consistently high hygiene standards apply to all staff involved in patient treatment and care. As staff members in this practice will frequently be exposed to patients with infectious diseases, all staff are required to wear clean clothes, wash hair regularly, wear their hair in a style that keeps it contained, wear a minimal amount of jewellery and not wear nail polish. This is imperative for infection control purposes. It is a health and safety requirement that all staff wear enclosed footwear.




8.5 Transmission based precautionsTransmission-based precautions are used with standard precautions to further reduce transmission opportunities arising from specific transmission routes of microorganisms.

Patients are advised why these measures are needed to protect all patients and staff from infection.

Transmission-based precautions include the use of:

Contact precautions.

Droplet precautions.

Airborne precautions.

Patients will be encouraged to report any potential infectious disease to practice staff as soon as possible. Staff will be encouraged to stay home if carrying any potential infectious disease.

Signs in our reception and waiting area, and playing on our on-hold telephone message request patients tell reception if they are experiencing any particular symptoms or have travelled to any particular areas.

For example, in flu season, patients are encouraged to ask at reception for a face mask and to sit away from other patients to reduce transmission. Likewise, patients who may be carrying measles or chicken pox are seated by the nurse in a secluded area away from children and expectant mothers.

In a pandemic, if patients are not being directed to a flu centre, our practice will have a properly protected staff member controlling the door who can explain to patients the precautions being taken and only let in patients who will, for example, wear a mask and agree to segregation, preferably in a designated room with a separate entrance/exit.




8.5.1 Contact precautionsContact precautions should be used if there is a risk of direct or indirect contact transmission of pathogenic microorganisms (such as MRSA and Clostridium difficile) that are not effectively contained by standard precautions alone. To prevent contact transmission, the following items and actions are required:

Staff will wear gloves for all manual contact with patients, associated equipment and the immediate environment.

Staff will wear a water impermeable apron or gown if clothing could be in substantial contact with the patient or their immediate environment.

If a splash is likely during the procedure, staff will wear use a fluid-repellent surgical mask and goggles or a face shield to protect the face.

Staff will clean hands immediately after attending to the patient and before leaving the area.

Staff will ensure all equipment that is in contact with the patient is single use or reprocessed before use on the next patient.

Depending on the situation and space constraints, staff will segregate patients with these types of infectious diseases (social distancing) – move the patient from the general waiting area to a spare room.

Staff will communicate the patient’s infectious status to other doctors and health professionals involved in the care of the patient (eg the practice nurse or ambulance and emergency department staff if being transferred to another healthcare facility) so that appropriate transmission-based precautions can be maintained


Physical factors, Chapter five – Management and disposal of waste Physical factors, Chapter five – Removal and disposal of personal protective equipment




8.5.2 Droplet precautionsDroplet precautions should be used if there is a risk of infectious microorganisms being transmitted by droplets generated by coughing, sneezing or talking (eg patients with influenza). To prevent droplet transmission, the following items and actions are recommended:

Staff will be offered appropriate immunisation for vaccine-preventable diseases.

If not immune, staff will use a fluid repellent surgical mask to protect the mouth and nose.

Staff will wash hands immediately after attending patient and removing mask (and face shield if used) before leaving the area.

Patients with these types of infectious diseases should be segregated (social distancing) if possible – ie move the patient from the general waiting area to a vacant area, or maintain a one metre gap between the infectious patient and other patients in the waiting area.

Ask the infectious patient to wear a surgical mask. In this instance, advise patients how to remove and dispose of the mask safely.

Ask the patient to attend to respiratory etiquette

Covering the mouth and nose when coughing and sneezing.Using tissues to contain secretions, and disposing of tissues after use in bin provided.Attending to hand hygiene with soap and using water and disposable towels to dry hands, or

using an alcohol-based hand rub. Consider explaining the situation to nearby patients.

Communicate the patient’s infectious status to other doctors and health professionals involved in the care of the patient (eg ambulance and emergency department staff if the patient is transferred to another healthcare facility) so that appropriate transmission-based precautions can be maintained.




8.5.3 Airborne precautionsAirborne precautions should be used where there is a risk of transmitting microorganisms generated by coughing, sneezing or talking that remain infectious over time and distance when suspended in air (eg measles, varicella, tuberculosis). To prevent airborne transmission, our practice will take the following precautions:

Staff will be offered appropriate immunisation for vaccine-preventable diseases.

If not immune, staff can use a P2/N95 close-fitting, high-efficiency filtration mask. Standard surgical masks are not particularly effective for this purpose.

In order to minimise exposure time to other patients, consider:

Consulting the patient ahead of others in the waiting area or schedule the appointment at the end of the session

Segregating into a separate area such as a spare roomAsking the infectious patient to wear a surgical maskExplaining the situation to patients waiting nearbyVisiting the patient at home.

Use goggles/face shield to protect the face if splash is likely.

Clean hands immediately after attending the patient and removing mask (and face shield if used) before leaving the area.

Ensure all equipment in contact with the patient is single use or reprocessed before use on the next patient.

Communicate the patient’s infectious status to other doctors and health professionals involved in the care of the patient (eg ambulance and emergency department staff if transferred to another healthcare facility) so that appropriate transmission-based precautions can be maintained.




8.6 Use of personal protective equipment As recommended in the RACGP Infection prevention and control standards for general practices and other office-based and community-based practices 5th edition

Requirement Airborne transmission Droplet transmission Contact transmission

Gloves No No For all manual contact with patient, associated devices and environmental surfaces.

Impermeable gown, apron

No No Use when health professional’s clothes are in substantial contact with the patient (including items in contact with the patient and their immediate environment).

Mask Yes Yes Protect face if splash is likely.

Goggles/face shield Protect face if splash is likely.

Protect face if splash is likely.

Protect face if splash is likely.

Special handling of equipment

Single use equipment or reprocess after patient use (includes all equipment in contact with patient).

No Single use equipment or reprocess after patient use (includes all equipment in contact with patient).

Other Encourage patient to use respiratory etiquette.

Segregate patient if possible.

Give patient a mask to wear if segregation is not possible.


Encourage patient to use respiratory etiquette.

Segregate patient if possible.

Give patient a mask to wear if segregation is not possible.


Encourage patient to use respiratory etiquette.

Wash hands after removing gloves and gowns.





8.6.1 Removal and disposal of personal protective equipment PPE needs to be removed in the following order:

Remove gloves inside out. Dispose of into the appropriate waste stream.

Perform hand hygiene.

Remove goggles. Place disposable goggles into the appropriate waste stream. Reusable goggles are cleaned and disinfected before reuse.

Remove gown, taking care not to touch surfaces exposed to contamination.

Dispose of disposable gown into the appropriate waste stream. Reusable gowns are placed into a linen bag marked ‘contaminated’.

Remove mask, taking care to handle by the strings only. Dispose of mask into the appropriate waste stream.

Perform hand hygiene.

The types of equipment used and method of disposal will vary with the situation – not all situations will require a mask or disposal into a biohazard bag. If PPE is not contaminated with pathogenic microorganisms, it may be disposed of into the general waste stream. If contaminated with a pathogen, it may require disposal into a biohazard bag and clinical waste stream.


Physical factors, Chapter five – Management and disposal of waste




8.7 Methods of hand hygieneAny pathogenic microorganism transmitted by contact or droplet can potentially be transmitted by touch. Hand hygiene refers to any action of hand cleansing that reduces the number of microorganisms on hands.

Effective hand hygiene is an essential element of all infection prevention and control policies.

Effective hand hygiene, using soap and water, antiseptic hand wash or alcohol-based hand rubs or wipes, has been proven to reduce the spread of infection.

Gloves are not a substitute for hand cleaning.

Easy access to hand-hygiene facilities enables staff to clean their hands more reliably.

Selecting the correct hand-hygiene product is essential in ensuring the hands of staff members are adequately cleaned and disinfected if necessary.

Hands need to be thoroughly dried following washing with liquid soap and water.

Staff need to be regularly educated on effective hand hygiene and hand care.

For more information:

Five Moments for Hand Hygiene. World Health Organisation. http://www.who.int/gpsc/tools/Five_moments/en/

How to hand rub – How to hand wash poster. World Health Organisation. http://www.who.int/gpsc/tools/GPSC-HandRub-Wash.pdf?ua=1



http://www.who.int/gpsc/tools/GPSC-HandRub-Wash.pdf?ua=1

http://www.who.int/gpsc/tools/Five_moments/en/


8.8 Fingernails and jewellery Our practice Infection Control Officer will complete a risk assessment on the risk of jewellery, artificial nails and nail polish worn at work.

Areas under the nail can harbour high concentrations of bacteria even after hand-washing, hence nails should ideally be kept short (not past the tip of the finger pad) and clean.

The skin under rings may be more heavily colonised than comparable skin without rings and rings can interfere with hand-hygiene techniques. Hence, jewellery should be kept to a minimum when at work.

Staff providing clinical services

This category includes nurses, medical practitioners and medical students and any staff deemed to be a risk by the Infection Control Officer

Clinical staff will keep fingernails short (not past the tip of the finger pad) and clean.

Jewellery (including rings, watches and other wrist jewellery) will be kept clean and to a minimum.

Jewellery will be removed prior to any procedural work.

Administrative staff

This category includes reception staff, management, payroll and any staff not in direct contact with patients or deemed not a risk by the Infection Control Officer

Administrative staff will keep fingernails clean and not excessive in length.

Jewellery (including rings, watches and other wrist jewellery) will be kept clean and to a minimum.

Patient hand hygiene

Our practice staff will assess appropriate circumstances for patient hand hygiene and provide suitable facilities, such as:

Alcohol-based hand rubs at the reception desk and in the waiting room

Liquid soap will be available in the staff and patient toilets with a copy of the World Health Organisation (WHO) How to hand wash poster displayed

Paper towel OR clean, dry, single use cloth towel OR roller towel OR a hot air dryer will be available for hand drying in the staff and patient toilets




Staff hand hygiene

The World Health Organisation ‘5 moments for hand hygiene’ recommends the following strategy for health care workers:

Occasion Description

Before patient contact When: Clean your hands before touching a patient when approaching him/her

Why: To protect the patient against harmful germs carried on your hands

Examples: Shaking hands, helping a patient to move around, clinical examination

Before an aseptic task When: Clean your hands immediately before any aseptic task

Why: To protect the patient against harmful germs, including the patient’s own germs, entering his or her body

Examples: Oral/dental care, secretion aspiration, wound dressing, catheter insertion, preparation of food, medications

After body fluid exposure risk

When: Clean your hands immediately after an exposure risk to body fluids (and after glove removal)

Why: To protect yourself and the health-care environment from harmful patient germs

Examples: Oral/dental care, secretion aspiration, drawing and manipulating blood, clearing up urine, faeces, handling waste

After patient contact When: Clean your hands after touching a patient and her/his immediate surroundings, when leaving the patient’s side


Examples: Shaking hands, helping a patient to move around, clinical examination

After contact with patient surroundings

When: Clean your hands after touching any object or furniture in the patient’s immediate surroundings, when leaving - even if the patient has not been touched


Examples: Changing bed linen




Table: Methods of hand hygiene

As recommended in the RACGP Infection prevention and control standards for general practices and other office-based and community-based practices 5th edition

Type of hand hygiene

Technique Duration Drying When

Routine hand cleaning for soiled hands

Washing: Wet hands Wash with neutral liquid soap Rinse thoroughly Use paper towel to turn off

taps if not hands free

10–15 seconds

Paper towelOr clean, dry, single use cloth towelOr clean section of roller towel

Before eating After going to

the toilet Before and

after patient contact

After removing gloves

Skin disinfectants: Remove soil first, using hand

wipes or soap and water Apply alcohol-based hand rub Rub over all surfaces in the

same manner as washing hands

10–15 seconds, or until dry

Rub hands until dry, without wiping

Before eating After going to

the toilet Before and

after patient contact when hands are not visibly soiled

After removing gloves

Hand washing for standard aseptic (clinical) procedures

Method: Wet hands Wash with neutral liquid soap

or antimicrobial cleaner Rinse thoroughly Use paper towel to turn off

taps if not ‘hands free’ Alcohol-based hand rub can

be used in emergency situations outside the practice, provided hands are not visibly soiled

1 minute Paper towel or clean, single use cloth towel

Before any procedures requiring a clean or ‘no touch’ technique

Hand washing for surgical aseptic procedures

Method: Remove jewellery Wet hands and forearms Wash with antimicrobial

cleaner (4% chlorhexidine or 0.75% detergent-based povidone or 1% aqueous povidone)

Clean under nails only if needed (do not scrub hands with nail brush as they can break the skin and be a source of infection)

Rinse carefully, keeping hands above elbows

If taps are not hands free ask

First wash of day: 5 minutes

Subsequent washes: 3 minutes

Sterile towels

Before significant invasive surgical procedures




Type of hand hygiene

Technique Duration Drying When

another staff member to turn off taps or use sterile towel

8.9 Safe sharps managementIt is the policy of this practice to minimise the risk of injury to both staff and patients, and prevent the possible transmission of disease by discarded sharps. Therefore, the staff member who generates a sharp is responsible for the safe disposal of that sharp. In other words, in this practice, if you used it, you must dispose of it. This responsibility cannot be delegated.

Sharps represent the major cause of accidents involving potential exposure to blood-borne diseases. All sharp items contaminated with blood and body fluids must be regarded as a source of potential infection. Safe handling and disposal of sharps is essential to protect the operator and staff from injury and possible transmission of disease.

Sharps may be defined as any object or device that could cause a penetrative injury.

All needles/syringes.

Scalpel blades.

Punch biopsy equipment.

Lancets.

Wire cytology brushes.

Razor blades.

Pins used for neurosensory testing.

Stitch cutters.

Broken glass.




8.10 Use, removal and disposal of sharps containersSharps containers will be available in all areas where sharps are or may be generated.

Sharps containers must conform to Australian Standard 4031 Non-reusable containers for the collection of sharp medical items used in health care areas. This is a yellow container made from puncture resistant material which displays a biohazard label.

In our practice, sharps disposal units will be available:

In the nurses station.

In all doctors/nurses consulting rooms.

In the treatment/procedure room.

In the patient and staff toilets.

Sharps containers will

Not be stored on the floor.

Not be stored in a location accessible to children.

Be properly mounted to prevent falling over.

Be securely closed and replaced once ¾ full.

All staff must undertake the following procedure when disposing of sharps:

1. When preparing to use sharps, staff will plan ahead and have a sharps disposal unit or kidney dish readily available.

2. Place disposable sharp articles and instruments into a sharps disposal container immediately after use or at the end of each procedure, whichever is more appropriate.

3. Sharps must be placed in a yellow puncture-resistant container bearing the black biohazard symbol (AS 4031).

4. Injection trays must be used to transport the needle and syringe to and from the patient.

5. Ensure sharps containers are not placed directly over other waste or linen receptacles.

6. Obtain assistance when taking blood or giving injections to an uncooperative patient or to a child

7. Used sharps/needles must not

Be removed from disposable syringes.Be carried about unnecessarily.Be bent or broken prior to disposal.Be recapped (unless using specifically designed equipment).

8. Do not forcefully insert items into a sharps disposal container.

9. Do not fill the container past the level marked or three quarter level.

10. Injuries can occur whilst trying to force the sharp into a too full container.

11. Ensure the lid is sealed once the container is full.

12. For push-on lids, use both hands and apply pressure only to the edges of the lid.

13. Do not place sharps containers on the floor or in areas where unauthorised access or injury to children can occur.




14. Do not reopen a full sharps container.


<Option 1>

For removal and disposal of the container, phone the <name of sharps disposal service> to arrange pick-up and exchange with new containers. Ensure this is done when there is one empty container available. Do not wait for the last container to be filled before contacting to arrange exchange.

<Option 2>

All filled sharps disposal containers are treated as other contaminated waste. They are sealed and placed in the large contaminated waste bin. For removal and disposal of the bin, follow the instructions detailed under ‘Waste Disposal’ above.

8.11 Single use equipmentWherever possible, single use sterile disposable equipment is used when tissue, which is normally sterile, is penetrated. Single use packaging is the only acceptable presentation for dressings, suture materials, suture needles, hypodermic needles, syringes, scalpels and pins used for sensory testing.

Single packaging of local anaesthetics is highly recommended. Multiple dose containers of local anaesthetic (or other injectable substances) present an unacceptable infection hazard. If their use is unavoidable in the short term, a new sterile drawing up needle and sterile syringe must be used whenever material is removed from the container.

Sterile items marked by the manufacturer for single use MUST NEVER be reused under any circumstances on another patient because of the difficulties of cleaning and/or sterilising them and also because these procedures may damage the materials used in their construction.

Single use items of equipment contaminated with blood or body fluid fall within the category of designated infectious waste and are to be disposed of in the manner described in the section:

Physical factors, Chapter 8.8 - Safe Sharps Management




8.12 Reusable medical equipmentOur practice Infection Control Officer coordinates the assessment of the level of processing (cleaning and sterilising) required for reusable medical equipment used in our practice. All medical devices and equipment have been assessed in accordance with The Spaulding Classification and a Risk Assessment.

Table: The Spaulding Classification

Level of risk Application Process

Critical Entry or penetration into sterile tissue, cavity or bloodstream.

Sterility is required.

Semi critical Contact with intact non sterile mucosa or non-intact skin.

Sterilisation preferred where possible. If sterilisation is not possible then high-level chemical disinfection is required.

Non critical Contact with intact skin. Clean as necessary with detergent and water.

The instrument and equipment processing risk assessment will take into consideration what is reasonable in the processing of reusable equipment, such as:

The probability of harm to a patient.

The likely seriousness of the harm.

The feasibility of meeting all processing requirements in the practice.

Complying with the manufacturer’s instructions around the recommended use of equipment and products to ensure appropriate sterilisation.

All instruments, material, medications and fluids introduced into usually sterile tissue must be sterile. This includes all instruments used to penetrate skin or mucous membrane. Disinfection by chemical or thermal means is not an acceptable alternative.

Sterilised instruments intended for penetrating skin or mucous membrane must be stored in prepared packs or, if for immediate use, in a covered sterile tray. Packs must not be used if the outer packaging has been damaged.

For more information please see:

Safety, quality improvement and education, Chapter 2 - Clinical Risk Management Systems




8.12.1 Use of reusable medical equipmentSelect the most appropriate option for your practice, or create your own procedure

<Option 1> Disposable instruments only

Our practice does not use reusable medical equipment.

All instruments used in this practice are disposable.

It is the responsibility of all staff to ensure that such disposable instruments are placed in the correct storage bins (yellow topped contaminated waste bins). This waste must be removed from the practice in such manner as will ensure that there is no opportunity for patient to patient or patient to staff cross contamination.

Appropriate personal protective equipment must be worn when handling waste.

<Option 2> Reusable instruments sterilised off site

This practice utilises reusable medical equipment.

This includes various items for assessing patient health (eg specula, scopes, surgical instruments, and torches).

There are no facilities for sterilisation on the premises. All reusable medical instruments are sterilised off site with an accredited sterilisation facility <Name of offsite sterilisation provider>. Our practice maintains a documented agreement to detail the arrangements and responsibilities of each party. This includes:

Responsibilities for washing and packaging used equipment.

Expected turnaround time.

Responsible contact person.

Contingencies of process failure.

A copy of the provider’s accreditation certificate.

After each use, our practice team will manually clean reusable medical instruments in preparation for sterilisation as per the policy:

Physical factors, Chapter 8.10.1 - Manual cleaning of reusable medical equipment

Clean items will be placed in a clean labelled (unsterile reusable medical equipment) container for storage and transportation to <Name of offsite sterilisation provider>.

A second labelled container will be used by <Name of offsite sterilisation provider> to transport the reusable medical devices back to the practice after sterilisation.

Packs will be checked for Class 1 chemical indicator change, intact seals and damage before being released for use in the practice. Details will be recorded in the practice log.




<Option 3> Reusable medical equipment sterilised on site

The practice has a supply of reusable medical equipment.

This includes various items for assessing patient health (eg specula, scopes, surgical instruments, and torches).

All reusable medical instruments are sterilised on site.

After each use, our practice team will manually clean reusable medical instruments in preparation for sterilisation as per the policy Physical factors, Chapter 8.10.1 - Manual cleaning of reusable medical equipment, followed by sterilisation.




8.12.2 Manual cleaning of reusable medical equipmentProcedure

1. Wash hands with liquid soap and dry thoroughly with paper or single use towel.

2. Put on personal protective equipment including goggles, apron and long kitchen gloves.

3. At point of use, pre-clean dirty instruments by opening instruments, dry- or damp-wiping off gross soil and/or rinsing under gently running tepid water in the dirty sink/basin.

4. If unable to clean instruments immediately after use, open instruments and soak in a bowl or container with tepid water and detergent until they can be cleaned.

5. Prepare dirty sink/basin by filling with tepid water and detergent based on the manufacturer’s instructions.

6. Thoroughly wash each instrument under the waterline in the dirty sink to remove all organic matter. Scrub instruments with a clean, firm-bristled brush and use a thin brush to push through lumens, holes or valves.

7. Inspect instruments to ensure all matter has been removed.

8. Rinse the washed instruments in gently running hot water in the clean sink/basin.

9. Place each washed instrument on lint free cloth and repeat the above process until all instruments have been cleaned and rinsed.

10. Carefully dry each instrument with clean, lint free cloth shortly after being cleaned (dry gloves must still be worn). Do not allow to air dry.

11. Still wearing gloves, place items in a clean labelled (unsterile reusable medical equipment) container for storage before packing if not being further processed immediately. If being processed immediately after drying, place into or onto the sterile barrier system (eg pouch or Kimguard wrap) in one action to save double handling.

12. Carefully discard dirty water down the sink with gently running tepid water. If using a basin, aim to pour the dirty water directly into the plughole.

13. Wash cleaning brushes/cloths with detergent and tepid water after every use and sterilise the brushes in the last load of the day.

14. Wash the dirty and clean sink by rinsing it with tepid water and detergent. Rinse with hot water daily. Dry and wipe down the sink with a disposable towel.

15. Remove personal protective equipment including goggles, apron and kitchen gloves.

16. Clean personal protection equipment by washing with detergent and tepid water after every use and dry.

17. Wash hands with liquid soap and dry thoroughly with paper or single use towel.




8.13 Equipment processing areaPolicy

Used items will be cleaned in the designated ‘dirty’ area to prevent possible contamination of processed items. Work surfaces must be made of a smooth, non-porous material without cracks or crevices to allow for efficient cleaning.

The area must include:

Hand washing facilities (separate from equipment decontamination sink).

Adequate bench space.

Good lighting.

Bins for specific waste.

Adequate storage space for materials and equipment.

The workflow pattern of systematically moving items from ‘dirty to clean’ must enable items to progress from the cleaning area to sterile storage area without re-contamination.

8.13.1 SinksPolicy

Our practice has the following sink set up in our equipment processing area:

<<Option 1>> Two sinks

One ‘dirty’ sink designated for washing; and

One ‘clean’ (or cleaner) sink for rinsing the washed reusable medical devices.

When disposing of waste water from cleaning, rinsing bloody linen and cleaning buckets and mops a sluice or a laundry sink may be used.

<<Option 2>> One sink

One labelled and suitably sized container acting as the ‘dirty’ sink for washing used reusable medical devices.

One physical sink as the ‘clean’ sink to rinse reusable medical devices.

Use the single sink to dispose of the water from the ‘dirty’ container and rinsing items.

When disposing of waste water from cleaning, rinsing bloody linen and cleaning buckets and mops a sluice or a laundry sink may be used.

Procedure

All sinks and any containers will be cleaned after use with water and detergent as well as regularly cleaned and dried to reduce contamination.

A sluice or laundry sink can be considered for disposing of waste water from cleaning, rinsing bloody linen and cleaning buckets and mops. The sluice or laundry sink is best located in the practice laundry or utility room.




8.13.2 Bench topsBench tops will be cleaned and dried daily and after each use. If space is restricted, an area can be made temporarily clean by placing a sheet of disposable plastic-backed paper or a suitably labelled tray or container in the area.

8.13.3 Suggested processing area design and layout

Reference:

Suggested processing area design and layout. RACGP Infection prevention and control standards: For general practices and other office-based and community-based practices.



CleanDirty

Packaging

Sterilising

Storage

Use of instruments

Dirty instruments

Pre-cleaning

Cleaning

SteriliserWith a daily steriliser log book for each machine

FlooringFlooring that is easy to clean, and is not slippery when wet

Waste disposal Bins for disposal of general, contaminated waste, and sharps

Ultrasonic cleanerAn ultrasonic cleaner can be used if desired

Hand washing sinkA clearly marked separate sink for hand washing is desirable

Sharps disposalA securely fastened sharps container

Storage areaAdequate storage area for cleaning, packaging and sterile instruments

Cooling areaA clean area for allowing sterilised packs to cool before storage

Instruments awaiting sterilisationA labelled container for instruments awaiting sterilisation

Packing areaA clean separate area for packing is recommended

Drying areaA drying area is positioned near the clean sinkDirty and clean sinks

Two labelled and separate sinks for cleaning dirty equipment and for rinsing


8.14 Sterilisation Sterilisation involves the complete destruction of all forms of microbial life, including bacteria, viruses and spores. To be effective, meticulous cleaning (mechanical or manual) to remove all foreign material from objects prior to undergoing sterilisation must precede sterilisation. All items introduced into normally sterile tissue, sterile cavities or the bloodstream must be sterile.

Our practice staff will be trained in the appropriate use of different sterilising methods including:

Dry heat sterilisation; and

Steam sterilisation (autoclaving);

The sterilisation method chosen must be:

Compatible with the item to be sterilised to avoid damaging the instrument; and

In accordance with the manufacturer’s recommendations.

Our practice will provide nursing staff with the appropriate training to correctly pack, seal and carry out sterilisation procedures. This may include advice or training may be available from a local hospital sterilising department, primary healthcare organisation or infection prevention and control provider.

8.14.1 Sterilisation by steam under pressure Steam at high temperature under pressure (autoclave) is the most reliable method of sterilising cleaned instruments and is recommended for use in general practice.

Small steam sterilisers are grouped by class of cycle and method of steam introduction.

Class N cycles are those without an active drying cycle. They are not suitable for sterilising packaged items as they cannot effectively dry the load and must not be used.

Class S cycles have an active drying cycle and may use some vacuum to assist air removal.

Class B cycles have an active drying cycle and use a vacuum to assist steam penetration and are suitable for sterilising very long, narrow, cannulated devices.

Our practice has a Class S cycle/Class B cycle steam steriliser (autoclave unit)

Specific instructions for the use of packaging and the autoclave will be displayed next to the machine. These instructions will include a comprehensive workflow schedule to ensure that there is no possible contamination of the clean areas where the sterile instruments are unloaded and stored by contact with dirty instruments.

All items to be sterilised will be thoroughly cleaned first.




8.14.2 Sterile barrier systems Reusable medical devices that are required to be sterile at the time of use must be protected by a sterile barrier system at all times. Instruments are to be packed into an appropriate sterile barrier system (eg pouch or Kimguard wrap) for sterilisation and storage until use.

Using sterile barrier systems will:

Provide an effective barrier against sources of potential contamination during storage.

Permit aseptic removal of the contents of the sterile barrier system at the time of subsequent use.

The placing of reusable medical devices into sterile barrier systems will take place in a ‘clean’ area adjacent to the cleaning area after the reusable medical devices have been dried.

If space is restricted, an area can be made temporarily ‘clean’ by placing a sheet of disposable plastic backed paper or a suitably labelled tray or container in the area to create this space.


<Option 1>

It is the policy of this practice that all instruments used for invasive procedures are wrapped in pouches, bags or material. All other reusable instruments that do need to be sterile on use are left unwrapped.

<Option 2>

It is the policy of this practice that all instruments used for invasive procedures are left unwrapped and used immediately following sterilisation. All other reusable instruments that do need to be sterile on use are left unwrapped.

Once reusable medical instruments have been thoroughly cleaned and dried they will be placed directly into or onto a sterile barrier system (eg pouch or Kimguard wrap) in one action to save double handling. If not being processed immediately, clean items may be placed in a clean labelled (unsterile reusable medical equipment) container for storage before packing.

Gloves (eg clean non-sterile utility) will be worn when placing items into a sterile barrier system in order to minimise contamination of the items.




8.14.3 Packaging reusable medical devices After instruments have been cleaned and dried, reassemble, unhinge and open them.

Pack instruments using wrapping, bags or pouches.

Use tip protectors if necessary to prevent sharp instruments from perforating the material

If using laminated pouches, pack hollow items such as bowls and kidney dishes open side against the paper.

Do not use pins, staples, string or non-adhesive tape to seal packages.

Place reusable medical devices with the handle towards the end of the sterile barrier system to be opened (when using laminate pouches or paper bags). This allows ‘sterile’ removal and decreases the possibility of injury from the instrument tip when the bag is opened.

Do not exceed the parameters of the validated ‘challenge pack’ (the hardest to sterilise). Photographs of the validated contents and their arrangement within the sterile barrier system are useful as a valuable ready reference.

If using tape, use one that is specific to the type of steriliser and compatible with the packing/wrapping material used (there are different tapes for paper and nonwoven materials).

Ensure that sterile barrier systems are sealed in such a way that air cannot enter after removal from the steriliser.

If using a self-sealing pouch, precisely fold seals along the ‘dotted’ lines.

If sealing wrapped items with tape, double fold joins and use several short strips across the join rather than a long length of tape along the joint. This ensures that when this type of sterile barrier system is opened, the tape can be broken across the join line, thus preserving the integrity of the sterile barrier system.




8.14.4 Labelling Place a Class 1 chemical indicator on the pouch or bag. Note that most pouches have a peel-

off strip that is also a Class 1 chemical indicator which can be inserted inside the pouch. Other pouches or bags may have a Class 1 chemical indicator manufactured into the packaging.

If the steriliser does not have a printer, then a Class 4, 5 or 6 chemical indicator should also be included in one pouch and/or on the tray.

Seal or close the pack with tape (2-3 folds) or heat seal to ensure that no air is able to enter.

Inspect the pack to ensure packaging material is intact.

Use a felt-tip, non-toxic, solvent based marker pen to label the pack with the following minimum details:

Date of sterilisation; and The load number.

If appropriate, additional labelling may include:

Steriliser identification (in practices using more than one steriliser).Identification of the contents if items are not clearly visible (eg when using paper bags or wraps

or if reusable medical devices within a kidney dish are sterilised in laminate pouches, as the hollow side faces the paper).

Identification of the person responsible for cleaning and placing items in the sterile barrier system (only in practices with several staff preparing items, as this allows staff counselling should cleaning or the sterile barrier system be found to be defective).

Location of storage post-sterilisation (this may be applicable in larger practices to enable storage of different packs in different locations, for example, ‘downstairs plastics set’, ‘small treatment room suture pack’).

Record details in the Sterilisation Log.




8.14.5 Loading the steriliser Correct loading of sterilisers is essential to successful sterilising:

To allow efficient air removal.

To permit total steam penetration of the load.

To allow proper drainage of condensation and to prevent wet loads.

Prevent damage to items in the load.

Maximise efficient utilisation of steriliser.

When loading the steriliser, care needs to be taken that the steam can circulate effectively and that all surfaces are accessible and exposed to steam.

This practice follows this process when packaging instruments.

1. Load items into the steriliser following these points:

Follow the loading instructions provided by the manufacturerAllow enough space between each item to allow air circulation, steam penetration and drying to

occur.Do not crush items together.Use load separator to pace items that would stack closely together, eg kidney dishesDo not allow items to touch the floor, top or walls of the chamber.Follow the pattern of loading described in the practice validation protocol when doing a full

load.2. When loading bags or pouches:

Ideally load vertically (on edge)Separate regular-shaped bags and pouches with a rack; irregular-shaped bags and pouches

can be placed against each otherFace multiple bags and pouches the same way (the paper side of a laminated bag or pouch

should face the laminated side of the next bag or pouch)Face pairs of bags or pouches paper to paperIf loading a laminate pouch horizontally on a tray, position with paper side down to enable air

removal and steam penetration.3. Monitor the sterilisation process by one of the following:

Automatic printout or computerised data logger download (records at a minimum of 60 second intervals).

Insert a Class 4, 5 or 6 chemical indicator in the load. This can either be on the tray or inside packaging.

Manually record time and temperature throughout the cycle at least every 30 seconds.4. Fill the chamber with or ensure reservoir has sufficient deionised/demineralised water as per

the manufacturer’s instructions.

5. Turn on electricity, ensure printer is ‘on’ and has sufficient paper.

6. Close and secure chamber door as per manufacturer’s instructions.

7. Press ‘Start/Pouch’ button or relevant button to commence the cycle as per manufacturer’s instructions.




8.14.6 Processing timeAll times are based on the assumption that the items to be sterilised are thoroughly clean.

Processing time

The time selected for sterilising a load is a critical factor in ensuring sterility of the load. The total processing time is the sum of the penetration time and the holding time.

Often manufacturers pre-set the processing time on sterilisers. These times must be checked and altered if necessary to ensure adequate time at temperature to kill all microorganisms.

Penetration (equilibration) time

Penetration time is the time it takes to reach the hardest part of the load to achieve the required temperature once the chamber has reached that temperature. The hardest to reach part is usually the centre of the ‘challenge pack’ within the ‘challenge load’. This time difference will vary depending on the type of steriliser and each type of challenge pack/load. It is important not to exceed the maximum load specifications of the manufacturer.

The density of the challenge pack/load determines the penetration time. For example, laminate pouches containing up to four small reusable medical devices can be safely assumed to have a penetration time of zero. Wrapped packs and packs containing gauze or other textiles are denser and more difficult for steam to penetrate and require formal assessment of the penetration time by a service technician. This can be done when commissioning the steriliser or at validation.

Holding time

The holding time is the time the whole load must be held at the sterilising temperature. The holding time includes a safety factor.

The holding time depends on the temperature selected (eg 121°C for 15 minutes holding time or 134°C for 3 minutes holding time).

Drying time

Drying time needs to be established for all the different challenge pack/loads the practice intends to sterilise.

Procedure

STERILISATION TIME = PENETRATION TIME + HOLDING TIME + SAFETY FACTOR

Temperature (degrees Celsius)

Pressure Holding time (minutes)kPa psi Mb

121C 103 1030 15 15 minutes

126C 138 1380 20 10 minutes

132C 186 1860 27 4 minutes

134C 203 2030 30 3 minutes

Reference: Recognised temperature, pressure, time relationships (AS/NZS 4815:2006).




8.14.7 Monitoring of the sterilisation processMonitoring is a programmed series of checks and challenges, repeated periodically, and carried out according to a documented protocol which demonstrates that the process being studied is both reliable and repeatable.

If the temperature or pressure of the steam inside the autoclave is above or below what it should be, the steam will not be able to condense and sterilisation will be unreliable. It is therefore vital that the efficiency of the sterilisation process is checked on a regular basis according to the manufacturer’s specifications or those documented by be Australian Standard AS 4187- 1994.2

Our practice follows these methods of monitoring.

Test Processed

Method Class 1 chemical indicator

Frequency Every wrapped item (external); or Every load, if unwrapped.

Test Time, temperature and pressure

Method Use a steriliser with a printout facility; or Data logger/computer download; or Manually recording of temperature throughout the cycle; or Class 4, 5 or 6 chemical indicator.

Frequency Every load

Test Calibration

Method By a qualified service technician.

Frequency 6 - 12 monthly

Test Validation

Method See definition and process below (8.14.11 Validation of the sterilisation process)

Frequency 12 monthly




8.14.8 Unloading the steriliserFor items wrapped in porous packaging materials, the period of time between their removal from a steriliser (any type) and their return to room temperature is recognised as being the most critical time with respect to assurance of sterility.

Cooling generates a tiny flow of room air into the pack at flow rates demonstrated to breach porous packaging materials leading to their failure to provide a microbiological barrier.

Correct cooling practice is essential to maintain sterility. When a sterile item is not cooled in the correct manner the article can have moisture build up, which can contaminate stock. The item must be discharged if the packaging is torn, punctured or wet.

This practice follows this process when unloading the steriliser.

1. When cycle is complete, check printout to ensure the temperature has reached 134°C and stayed above 134°C for the specified period of time.

2. Note a minimum of 3 minutes is required for unwrapped goods. These measurements need to be confirmed by a technician, known as penetration time and time at temperature testing.

3. Circle and sign these parameters on the print-out and attach to the Sterilisation Log.

4. Open the steriliser door to its maximum to allow contents to cool.

5. Remove the load from the steriliser as soon as the cycle has finished. Do not place hot rack or tray on a cold surface.

6. Allow the load to cool in an area away from high levels of activity before being handled, as hot packs are easily contaminated or damaged.

7. Visually check that the load is dry (do not touch until cool).

8. Check sterile barrier system(s), chemical indicator(s) and printouts. Log the results.

9. Report any failures. All items in a failed load must be rejected, the fault identified and corrected, and the entire load reprocessed in a new sterile barrier system.

10. Store the contents of a successful load for later use.

Any sterile barrier systems that are wet, dropped, torn, damaged, or have broken seals are considered unsterile and must be reprocessed. This reprocessing involves repackaging in a new sterile barrier system.

Re-cleaning is required only if the reusable medical devices have been contaminated. Any reprocessing must be recorded




8.14.9 Storage of sterilised equipmentAll sterile items, including those processed in the practice facility and those procured from commercial supplies, shall be stored and handled in a manner that maintains the sterility of the packs and prevents contamination from any source.

Factors that influence shelf life are event-related (not time-related) and are dependent on storage and handling conditions.

Instruments in this practice are stored in the following conditions:

Clean, dry and well-ventilated area.

Area must be free from draughts and dust.

Preferably a closed-door cupboard located in an area where there is reduced chance of contamination from dust and water.

Dust covers must be used if stored for a long period of time.

Instruments must be rotated, eg place recently used items at the back and take from the front.

The contents of the package must be clearly visible to reduce handling of instruments.

Never use rubber bands to hold items together as they will cut through packaging.

Store disinfected items in containers with fitted lids as long as the lid is tightly closed.

Regularly wipe storage area with a damp cloth to prevent dust build-up. It is also essential to dry the area before replacing packs.




8.14.10 Documenting the cycleDocumenting the entire sterilisation process is important for quality assurance and review purposes so that any doubts about the sterility of a particular item or load can be identified.

For every cycle, the <person responsible for sterilisation> will record the following information in the steriliser logbook:

Cycle date.

Steriliser identity (if the practice has more than one steriliser).

Load number.

Load contents.

Identity of the person who prepared the load.

Results of the cycle monitoring (pass/fail). The printout of the cycle can be attached to the logbook and verified as correct in the logbook. If a data logger is used, verify in the logbook that the data logger recording was viewed and is correct. If manual recording is used, record temperature versus time.

Class 1 chemical indicators change.

Results of any other indicators used (eg chemical or biological).

Condition of the sterile barrier systems (ie dry, seals intact and no damage).

Signature of the person releasing or rejecting the load. In larger practices it may be necessary to record the name of each person involved in cleaning the items, placing them in a sterile barrier system and loading to enable follow up of any problems.

Comments regarding fault identification and corrective action taken.




8.14.11 Validation of the sterilisation processSterilisation

Successful sterilisation to achieve and maintain sterility of equipment and instruments reliably and repeatedly is a process which begins with pre-cleaning of equipment after use, cleaning of the instruments, drying, packaging, loading the chamber, the sterilisation cycle, unloading the chamber, monitoring of each cycle, recording cycle details and monitoring in the log book, storage and traceability of the sterilised equipment, detection of abnormalities in the process and corrective appropriate action, and daily, weekly and annual steriliser maintenance.

Validation

Validation is a documented procedure for obtaining, recording and interpreting the results required to establish that a process will consistently yield a product complying with predetermined specifications. Validation is required as part of the monitoring process.

Validation is a documented procedure for obtaining, recording and interpreting results required to establish that the sterilisation protocols/procedures followed by a practice will consistently yield sterile instruments and equipment, as exactly the same procedure is followed for every part of each sterilisation process.

Validation covers three activities, which are:

1. Commissioning.2. Verification of process specification.3. Performance qualification.The validation process must be carried out by practice staff in conjunction with a maintenance contractor annually. A qualified service technician must ensure that all gauges and process recording equipment fitted to the steriliser are calibrated using independent test equipment. The contractor must also document results of heat distribution studies on an empty chamber and conduct a penetration test using the practice’s challenge pack.

Validation must be performed:

After commissioning a new steriliser (after installation as per manufacturer’s instructions and its operation has been checked by a service technician).

Annually; and Immediately after significant changes which could adversely affect the result of the sterilisation

process are made, such as:Installation of an ultrasonic cleaner (cleaning).Return of the steriliser after repair offsite (sterilisation cycle).After major onsite repairs (sterilisation cycle).After significant changes to the sterile barrier systems or chamber loading (sterilisation cycle).

If validation of the sterilisation process is successful then any load subsequently processed over the next twelve months can be treated as sterile. This is provided that:

All the validated documented sterilisation procedures continue to be followed exactly. The pack contents, packing, and packaging and chamber loading do not exceed the

parameters of the validated packs/loading. Each cycle is monitored correctly and no changes are made to any part of the sterilisation

process which could adversely affect it.




8.14.12 Conducting validation This practice follows this process when conducting validation:

1. Review and perform your infection control policies and procedures including:

Workflow issues.Cleaning of instruments.Pack contents, packing and packaging.Loading of the steriliser.Sterilisation cycle.Unloading the steriliser.Storage of sterile items.Maintenance of the steriliser.

2. Check that the procedures were successful in terms of performance and reliability and sign-off each one using the Validation Methodology Checklist. Attach the Validation Methodology Checklist to the Validation Record.

3. At time of routine service, request service representative to:

Calibrate machine;Conduct a heat distribution study in an empty chamber;Calculate the penetration time (if not previously obtained and no changes to packing or

packaging); andProvide Servicing/Testing Documentation detailing the outcome.

4. Using the Validation Record template, record the following details:

Date of annual validation;Batch number and test indicator description;Temperature and time at which validation is being done; andAttach your Servicing/Testing Documentation to the Validation Record.

5. Select the hardest to sterilise items in terms of product or pack density to create your challenge pack and record details on the Validation Record.

6. Select the items that you will include in the load and record details on the Validation Record.

7. Label the test indicators to reflect each load, eg. 1-A, 1-B, 2-A, 2-B, 3-A, 3-B, Control Indicator, etc.

8. Place the test indicators inside the challenge pack, in the coldest spot of the chamber and outside of the steriliser. Record the location in the Test Indicator Diagram on your Validation Record.

9. Load the steriliser as documented above and draw details in the Loading Diagram on your Validation Record.

10. Do three consecutive, identical loads including the test indicators as marked. With each load, it is important to unpack and repack the challenge pack. All items for each load must be at room temperature.

11. Send the test indicators for testing/incubation or use an in-house incubator.

12. Document the findings and investigate any failures (a pass result is 100%).

13. Any load run subsequently and which does not exceed the parameters of the validated load can be treated as a load not requiring biological test indicators.

14. Attach this Checklist to the Validation Record.




8.15 Safe handling of pathology specimens1. After collection of blood and/or body substances place in the appropriate specimen container,

as specified by the testing laboratory.

2. Wipe the container clean to remove any visible soiling.

3. Securely seal to prevent any leakage during transport.

4. Place the container upright in a waterproof bag or container.

5. Take care to avoid contamination of pathology slips by keeping them separate from the clinical specimens.

6. For transport between institutions and interstate, pack the primary specimen, surrounded by sufficient material to absorb its contents, in a sealable inner container and provide a sealable outer container of waterproof, robust material. Label in accord with postal and other transport regulations. Keep cool if necessary.

8.16 Skin integrityMicro-organisms may enter the body via breaks in the skin. Healthy, intact skin on hands is a natural barrier to the invasion of infectious agents, even when the hands become contaminated with blood and body fluids.

All staff within the practice are therefore required to maintain the integrity of the skin on their hands and take precautionary measures if they have broken skin.

1. Daily inspection of the hands is to be carried out prior to commencement of work.

2. Cover cuts and abrasions on the hands with an occlusive dressing and use gloves if there is a risk of contact with blood and body fluids.

3. Do not use nail brushes routinely as they can break the skin.

4. Staff that have exudative lesions or weeping dermatitis are to seek medical advice regarding the need for treatment and possible re-deployment until the condition resolves.

5. Apply moisturising balm frequently to nourish dry skin.

8.17 Medication administrationThe use of single-use vials and single-use sterile injecting equipment is the most effective way to avoid cross infection via injection. If an agent is available only in a multidose vial, a new sterile needle and sterile syringe must be used to withdraw the contents of the vial. Both the needle and syringe are discarded after each use.

In no circumstances will any procedure allow the possibility of injecting contaminated material or fluid into a multidose vial. All injectable substances, medications and solutions are stored according to the manufacturer’s recommendations. Use-by dates are noted and stock rotated to ensure safety of clients and a minimum of wastage.




8.18 Management of blood and body fluid exposureBlood or body fluids need to be treated as potentially infectious substances that can transmit disease should contact occur.

Blood and body fluid spills need to be managed promptly.

Spills may be vomit, blood, urine or any other body substance. Blood or body substances (except sweat) need to be treated as potentially infectious materials that can transmit disease should contact occur.

In many instances, blood and bodily fluid spillage may be managed by thorough cleaning with a neutral detergent alone, but in some areas/situations disinfection may be desirable.

To prevent harm to others, it is vital that spillages are dealt with promptly. The following policy applies to all spillages in this practice.

Appropriate personal protective equipment (PPE) must be worn. For any cleaning that involves blood or body fluids the minimum PPE required is heavy-duty gloves, eye protection, an apron and enclosed footwear.

8.19 Spills KitWhen the spillage is in the form of blood or bodily fluids a spills kit is to be used.

The spills kit must be contained within a rigid-walled labelled container (eg bucket or plastic sealable box) and contain the following items:

A laminated guide with a list of spill kit contents and the management procedure.

Non-sterile or utility gloves.

Goggles/face shield.

Masks.

Disposable aprons.

Plastic (clinical and general) waste bags.

Kitty litter, polymerising beads or other absorbent material.

Paper towels.

Scrapers (eg two small pieces of cardboard).

Detergent to be made up when needed or detergent wipes.

Hazard sign to quarantine area.

Our practice spills kit is located at <location of spills kit>




8.20 Method for cleaning spillsAs recommended by the RACGP Infection prevention and control standards for general practices and other office-based and community-based practices 5th edition.

Standard precautions apply including personal protective equipment (PPE) appropriate to the task (eg gloves, goggles/face shield, apron – which are put on well away from the spill).

The method for cleaning spills will depend on the volume of the spill and where it occurs.

1. Wipe up and safely remove any solid matter and excess material.

2. If the spill is on a hard surface:

Clean with detergent and water.Dry the surface.Consider further treatment such as disinfection if site is large or in contact with skin. Dispose of contaminated material including PPE as per local requirements.

3. If the spill is on non-removable soft fabric or carpet:

Do not use liquid on the spill as this will spread the spill.Use kitty litter, polymerising beads or other absorbent material.Scrape up residue safely without causing material to disperse.Damp-pat surface (do not wipe or scrub) to remove further material.Dispose of contaminated material including PPE as per local requirements.Clean fabric or carpet with damp cloth (detergent and water) or recommended carpet cleaning

agent.Quarantine the area until the soft fabric or carpet is dry.

4. A disinfectant may be used after cleaning.

5. Hand hygiene should be performed after management of any spill.




8.21 LaundrySoiled linen can be a potential source of large numbers of pathogenic micro-organisms, however the risk of disease transmission is negligible and hygienic handling of linen will reduce the risk even further. Linen that has been protected with disposable paper or plastic does not need to be changed after each patient. However the disposable plastic or paper must be changed after each use.

Linen must be cleaned regularly. If it becomes contaminated with blood or body fluids, linen must be removed immediately and placed in the laundry bag. Prior to fitting new linen, the couch or other surface must be cleaned thoroughly with a water and detergent solution to remove any fluid residue.

If the linen is saturated with blood or body fluids, it should be placed in a leak proof bag so that the person doing the laundry can assess the linen before handling it and prevent further leakage.

Clean linen should be separated from used linen when transported and when stored. The storage area should be clean and dry.

Practice staff who handle used linen should wear personal protective equipment (PPE) and keep all linen and linen bags away from body contact.

Great care must be taken by general practitioners and staff not to accidentally dispose of sharps into linen. This puts the person processing the linen at risk of injury and infection.

8.21.1 How often to change linenDoctors and other health professionals need to assess the risk of infection to patients when considering when to change linen.

Linen needs to be changed if:

A patient requires the use of contact precautions, for example, is known or suspected of having CA-MRSA, scabies or lice.

There has been a blood or body fluid spill on the linen.

The linen is visibly soiled.

The linen has absorbed odour.

Other fabric items such as modesty sheets, blankets, pillow cases and towels all need to be similarly changed and cleaned. Cloth hand towels are a special case, and should only be used once before disposal as a single-use item or before being reprocessed.

There may be other circumstances where linen may be changed, such as before an operative procedure.

Appropriate use of reusable or disposable linen protectors can minimise linen usage.




8.21.2 Handling, changing, sorting and separation of used linenWhen changing or sorting dirty linen staff will wear appropriate personal protective equipment (PPE) such as gloves, an apron, safety glasses and a face mask.

Without shaking the linen - Check that sharps or other items are not caught up in linen.

Place used linen into the dirty linen wash bin (a covered, lined container). Our dirty linen wash bin(s) is stored in <<location of dirty linen wash bin>> (preferably in a ‘dirty’ utility area).

Linen that contains expressible blood or body fluids needs to be collected into a plastic bag before being placed in the dirty linen wash bin.

Linen should be handled with care; avoid shaking and throwing in patient care areas.

Place used linen in a laundry bag at the point of generation – if the dirty linen wash bin is stored elsewhere consider one on wheels.

Linen soiled with blood or body fluids should be placed into a leak proof plastic bag.

8.21.3 Cleaning linenSelect the most appropriate option for your practice, or create your own procedure

<<Option 1 >> Linen cleaned off site

Our practice uses the services of <Name of laundry service provider>.

<Name of laundry service provider> collects and cleans our laundry <frequency of cleaning>.The duties of the laundry are very specific and are detailed in the contract between the laundry and the practice.

Our dirty laundry will be processed by <Name of laundry service provider> as follows:

1. Pre-wash stain treatment Practice staff may apply a pre-wash stain treatment if laundry is contaminated. Appropriate PPE should be worn when undertaking the immediate treatment of blood and other stains. This can be by rinsing the blood or contamination off, applying an oxygenated stain remover or placing the item in a bucket of water with detergent or oxygenated stain remover to prevent the spill drying before washing.

2. Washing Either a hot or cold wash cycle with appropriate detergent should be used. Activated oxygen-based laundry detergents provide antimicrobial activity in addition to their stain-removing properties and are a good addition to the wash cycle. Chlorine bleach is also an economical, broad-spectrum chemical germicide but is not an appropriate laundry additive for all fabrics.

3. Drying Mechanical drying in a tumble dryer is the preferred method because of the effects of thermal disinfection. Regardless of whether hot or cold water is used for washing, the temperatures reached by this drying method provide additional significant antimicrobial action. The materials dictate dryer temperatures and cycle times but linen needs to emerge dry from a hot cycle.

4. Storage On return to our practice, clean linen will be stored in a clean, dry and dust-free environment <<location of clean linen storage>>




<Option 2>

This practice does not employ a laundry service. It is the responsibility of <Name of staff member responsible for laundry duties> to collect and clean our laundry <frequency of laundry>. The duties of cleaning the laundry are very specific and are detailed in the detailed in the staff member’s position description and are as follows:

1. Pre-wash stain treatment Practice staff may apply a pre-wash stain treatment if laundry is contaminated. Appropriate PPE should be worn when undertaking the immediate treatment of blood and other stains. This can be by rinsing the blood or contamination off, applying an oxygenated stain remover or placing the item in a bucket of water with detergent or oxygenated stain remover to prevent the spill drying before washing.

2. Washing Either a hot or cold wash cycle with appropriate detergent should be used. Activated oxygen-based laundry detergents provide antimicrobial activity in addition to their stain-removing properties and are a good addition to the wash cycle. Chlorine bleach is also an economical, broad-spectrum chemical germicide but is not an appropriate laundry additive for all fabrics.

3. Drying Mechanical drying in a tumble dryer is the preferred method because of the effects of thermal disinfection. Regardless of whether hot or cold water is used for washing, the temperatures reached by this drying method provide additional significant antimicrobial action. The materials dictate dryer temperatures and cycle times but linen needs to emerge dry from a hot cycle.

4. Storage On return to our practice rooms, clean linen will be stored in a clean, dry and dust-free environment <<location of clean linen storage>>




8.22 Management and disposal of wasteGenerators (the doctor and practice staff) of clinical and related wastes are required to comply with the Environmental Protection (Waste Management) Regulation 2000 (Regulation) and Environmental Protection (Waste Management) Policy 2000.

Waste management doesn’t just mean disposal, it also involves segregation, storage, moving and the eventual disposal of waste in a way that does not pose a risk to people and the environment.

Our practice has policies for:

The correct segregation of waste into three streams:

General waste;Clinical waste; and Related waste.

Storage of waste

Disposal of waste

Work health and safety procedures

Responsible person (monitoring, education of staff)

8.22.1 SegregationSegregation means sorting and separating wastes, at the point of generation, into various waste streams to allow appropriate storage, transport, treatment or disposal. A separate bin is used for each waste stream.

The underlying principles of waste segregation are to reduce the volume of hazardous waste destined for off-site disposal, to maintain safety standards during handling, transportation and treatment, and to eliminate the need for waste segregation to occur at disposal sites.

Practice staff also have a personal, public and environmental duty of care to make sure waste is appropriately segregated.

8.22.2 Cytotoxic wasteThis is material that is or may be contaminated by cytotoxic drugs during the preparation, transport administration of chemotherapy. This type of waste may have carcinogenic, mutagenic and or teratogenic potential.

Cytotoxic waste containers should have the same properties as clinical waste containers. They should be purple, display the telophase symbol in white and be labelled ‘cytotoxic waste’.

Unused or expired pharmaceuticals will be returned to pharmacies for safe disposal.

Disposal of this type of waste will be via an approved incineration facility.




8.22.3 Clinical (controlled) wasteThe WA Department of Environment Regulation regulates the transportation of wastes that may cause environmental or health risks. It does so through the application of the Environmental Protection (Controlled Waste) Regulations 2004. The Regulations provide for the licensing of Carriers, Drivers and Vehicles involved in the transportation of controlled waste on public roads in Western Australia.

The objectives of the Controlled Waste Regulations are:

To ensure the safe transportation of controlled waste to an approved location.

To monitor and track controlled waste to prevent unauthorised discharge into the environment.

To collate information to assist the Government in identifying priority waste management issues in Western Australia.

To provide an even and competitive system for companies in the waste management industry.

Clinical waste, as defined by the Environmental Protection Agency (Environmental Protection (Controlled Waste) Regulations 2004), is waste that has the potential to cause disease. In general practice this is primarily:

Discarded sharps (objects with sharp points or cutting edges such as used hypodermic or other medical needles, scalpel blades, lancets, and scissors);

Waste generated by medical, nursing, dental, pharmaceutical or other related activity which:

Is poisonous or infectious;Is likely to cause injury to public health; Contains human tissue or body parts;Contains human blood, fluids and tissue.

Any waste from patients known to have, or expected of having, an epidemiologically significant communicable disease (eg influenza) or are suspected or known to be colonised/infected with an antibiotic resistant organism (eg MRSA); or

Material that contains free flowing or expressible blood.

8.22.4 General wasteThis is any waste not classified as being within any of the categories of the clinical and related waste streams. General waste makes up the majority of our practice waste.

General waste includes tongue depressors, cotton wool balls, tissues, bandages, Band-Aids, and gloves, with no free flowing blood. It will also include office and kitchen waste and non-hazardous pharmaceutical waste (such as expired saline).

General waste can further be divided into recyclable and non-recyclable material.

Our practices will segregate our waste and provide receptacles for disposal of:

Recyclables (eg separate waste and confidential waste bins under desk, glass and plastic recyclables bin in the kitchen).

Waste contaminated with blood or body fluids that is not clinical waste (eg for disposing of tongue depressors, using a small bin mounted on a wall inaccessible to small children).




8.22.5 Pharmaceutical wastePharmaceutical waste may arise from:

Pharmaceuticals that have passed the recommended shelf life;

Pharmaceuticals discarded due to batches not reaching specification or contaminated packaging;

Pharmaceuticals returned by patients or discarded by the public;

Pharmaceuticals that are no longer required by the practice; and

Waste manufactured during the administration of pharmaceuticals.

Non-hazardous materials such as normal saline or dextrin need not be considered as pharmaceutical wastes.

Our practice team will return unused or expired pharmaceutical waste to a relevant authority such as a pharmacy or collection centre for appropriate disposal or distribution. Pharmaceutical waste can be disposed of in the clinical waste bin providing final disposal is via high-temperature incineration. If you are unsure of the final disposal method of waste, contact the waste disposal service <name of clinical waste disposal service> or local pharmacy.

8.22.6 Waste storageClinical or related wastes must be packaged, labelled, handled and transported appropriately to minimise the potential for contact with the waste and reduce the risk to the environment from accidental releases. It should be stored in an area not accessible to animals or unauthorised persons. It should also be stored in a manner that will not create an environmental nuisance.

Sharps must be placed into a rigid-walled, puncture-resistant container that meets the relevant Australian Standard for the type of container, and is the appropriate colour for the type of sharp. In general practice, this is always yellow as it symbolises that the item has been contaminated with blood. Once the sharps container has been sealed and secured, it can be placed directly into a secondary container for transportation. A suitable secondary container is the clinical waste bin. Purple for cytotoxic sharps may be used occasionally in some practices.

Clinical waste must be placed in yellow bags and containers and identified with the biohazard symbol and the words ‘Clinical Waste’. Normal plastic bags such as shopping bags are not a suitable alternative.




8.22.7 Moving wasteWaste must be moved around the practice in rigid-walled, puncture resistant containers. A rigid-walled container is one that has hard, unbending sides and is resistant to splitting, breaking and puncturing. The container must not allow liquids to leak or soak through.

Good waste management practice involves minimising exposure to the waste. To aid this, all movement of wastes throughout the practice should be planned to avoid busy times. Waste should not be moved through public areas nor general staff thoroughfares.

Appropriate personal protective equipment such as gloves, should also be worn to avoid potential injury. All persons responsible for handling waste (including staff and cleaners) should be trained in correct handling techniques. Waste must not be compressed by hand. To avoid potential spillage, bins should not be overfilled.

8.22.8 Waste disposalOur practice contracts the services of an approved clinical waste agency/waste remover that will treat and dispose of clinical and related waste according to the Regulations. Contractors will provide their EPA licence number for our records. Details of our waste disposal arrangements are specified in the service agreement. This includes destroying/treating clinical waste using high-temperature incineration and shredding confidential documents.

This practice utilises the services of <name of clinical waste disposal service> for disposal of our clinical waste. The bins are collected every <frequency of waste collection>. The contact details can be found in:

Our practice, Chapter 3 – Practice contacts.




8.22.9 Minimising waste productionIt is the policy of this practice that items for use in the practice will be purchased based on assessment of cost, appropriateness for the intended purpose and any contribution to waste in terms of both packaging and ultimate disposal. We consider that minimising the production of all waste will assist in cost savings and benefit the environment.

Not all medical waste is contaminated. Waste is to be segregated into contaminated and non-contaminated material. In this practice the following items are considered to be contaminated waste:

Item Description

Patient contact items Nappies, tampons, and soiled or used wound dressings.

Human derivatives Blood, urine, joint or other body fluids, excised skin, wound scabs/crusts, pus, and debrided tissue.

Medical items Swabs, used syringes and needles, scalpels, disposable specula, disposable scopes, punch biopsy equipment, used scalpel blades.

Special bins are provided for contaminated waste. These bins are marked yellow and bear the biohazard symbol. Only waste material described above is to be placed in these bins. Office paper waste, food scraps and other general waste can be disposed of via the normal refuse system. Recyclable items must be placed in separate containers and clearly labelled. When it is considered clinically appropriate and cost effective, re-useable items will be used in preference to disposable items.




8.23 Environmental cleaning Sound principles of basic hygiene are fundamental to effective infection control. Environmental cleaning must be regular and scrupulous. A good neutral detergent can be used for most of the cleaning requirements in a health care setting; this includes floors, walls, toilets and other surfaces. Disinfectants are expensive, often toxic and require contact times to be effective.

Work surfaces must be made of smooth, non-porous material without cracks or crevices to allow for efficient cleaning. Work surfaces must be cleaned and dried before and after each session, any gross soiling or bodily fluid spills must be cleaned as soon as possible in accordance with the correct procedures. Sinks and wash basins must be either sealed to the wall or sufficiently far from the wall to allow cleaning of all surfaces.

Damp dusting and wet mopping must be used in the cleaning of the environment. Dry dusting and sweeping will disperse dust and bacteria into the air and then resettle. It is potentially hazardous and inefficient, and must be avoided in patient treatment or food preparation areas. Equipment used to clean must be washed clean after use, dried and stored dry.

8.23.1 Scheduled cleaningSelect the most appropriate option for your practice, or create your own procedure

<Option 1>

<Name of cleaning service provider> cleans this practice <frequency of cleaning>. The duties of the cleaner are detailed in the contract between the cleaner and the practice and include our practice policies on

Occupational health and safety

Privacy and confidentiality

Infection prevention and control

Cleaning schedule and methods (see procedure below)

All cleaning equipment is stored in a clean and dry condition in an area not accessible to the public. Areas which are only cleaned and managed by appropriately trained practice staff are:

Spillage of blood or body fluids.

Medical instruments or items for reuse are cleaned according to the procedure for cleaning instruments and reusable items.

Treatment room benches and trolleys.

Consulting room benches containing medical equipment.

Infectious waste and sharps containers.




<Option 2>

This practice does not employ a cleaning service. It is the responsibility <name of staff member responsible for cleaning> to clean this practice<frequency of cleaning>. The cleaning duties are very specific and are detailed in the staff member’s position description.

All cleaning equipment is stored in a clean and dry condition in an area not accessible to the public. Areas which are only cleaned and managed by appropriately trained practice staff are:

Spillage of blood or body fluids.

Medical instruments or items for reuse are cleaned according to the procedure for cleaning instruments and reusable items.

Treatment room benches and trolleys.

Consulting room benches containing medical equipment.

Infectious waste and sharps containers.

Cleaning staff adhere to the following processes when cleaning:

Don personal protective equipment (PPE) such as gloves and a waterproof apron.

Make up water and detergent solution for each task to prevent a build-up of soil in the cleaning solution.

Use clean cloths and mops.

Wash and dry all surfaces.

Promptly dispose used cleaning solution in the dirty utility area, not in hand basins or clinical sinks.

Wash and dry buckets, cloths, mops and PPE after use.

Wash hands when each task is completed.

Make an entry in the cleaning record.




8.23.2 Example of a cleaning scheduleAs recommended in the RACGP Infection prevention and control standards for general practices and other office-based and community-based practices 5th edition

Surface Product Method FrequencySmooth surfaces, eg: bench tops, couches,

sinks, toilets and floors

High touch surfaces (eg door handles, light switches)

Detergent and water,damp cloth ORDisposable wipes

Wiping/rubbing with adamp cloth, or usedisposable wipes

Dry the surface with a clean cloth

As determined by thepractice (eg bench tops, sinks toilets andtreatment room floorsdaily, other floors every second day)

Smooth floors Detergent and water Mop and bucket

Damp mopping to ensure dust is captured and not dispersed into the air

As determined by the practice (eg daily)

Note: mops need to be cleaned and left to dry after use (not left wet in a bucket)Carpet (regular vacuum cleaning)

Vacuum cleaner Vacuum As determined by the practice (eg daily)

Carpet (spot cleaning) Spill kit or carpetcleaning solutionrecommended bymanufacturerORVacuum cleaner

Use spill kit to blot up excess moisture and other matter (eg vomitus)

Clean according to directions for use

Assist carpet to dry quickly (ventilation/ heating) and quarantine until dry

Use carpet cleaning solution for other spills

Use vacuum cleaner for solid objects

As determined by thepractice (eg When soiled)

Carpet (steam/dry cleaning)

Usually performed by a carpet cleaningcontractor with suitable equipment and products

Perform out of hours if possible

Assist carpet to dry quickly (ventilation/ heating) and quarantine until dry

As determined by thepractice (eg when soiled or yearly)

Fabrics, eg furniture Use a fabric cleaner recommended by the manufacturer ORDetergent and water

Clean according todirections for use and quarantine until dry

As determined by the practice (eg when soiled)

Other items, egstethoscopes, tapemeasures

Detergent and water, alcohol wipes

Clean thoroughly, wipeover with alcohol wipe but avoid on

As determined by the practice (eg monthly)




Surface Product Method Frequencystethoscope tubing

Toys Detergent and water Clean thoroughly As determined by the practice (eg when soiled or immediately if children are observed ‘mouthing’ toys, or monthly

8.23.3 Cleaning productsThis practice does not use cleaning agents or other chemicals, which are known to be toxic to the user (eg glutaraldehyde). Chemicals and cleaning agents used in this practice are properly labelled.

Decanting (transferring from one container to another) of any substances is strictly prohibited.

Topping up containers is strictly prohibited.

Solutions are made on a daily basis as required, discarded at the end of the day and the container thermally disinfected.

Detergents

Mildly alkaline detergents in the pH range of 8.0–10.8 are preferred over neutral pH detergents in most applications as alkalinity improves the detergent’s cleaning efficacy. Detergent products selected for general cleaning can have combined disinfecting abilities. Disposable detergent wipes may be used for spot cleaning.

Surface disinfectants

Disinfectants can reduce the number of microorganisms on a surface, but they are not a replacement for thorough cleaning. The cleaning process determines the effectiveness of any disinfectant.

Disinfectants have been shown to fail where prior cleaning is non-existent or ineffective.

Disinfectant use is not mandatory but may be used following cleaning with detergent and water, and can be combined with detergent in some products. Disinfectants should be considered when there is a risk of contamination with infectious agents and can be combined with detergent in some products.

Cleaning tools

Buckets and mop heads need to be washed then rinsed clean in hot water after use, and the mop heads wrung out and hung to dry. Wet mops can develop unacceptable levels of contaminating bacteria.

Reusable cleaning cloths need to be cleaned (washed) and dried (hung out or mechanically dried) after use, when wet or soiled. Sponges do not dry easily and their use should be avoided.

The cleaning the clinical areas and toilets will be cleaned using either detergent wipes or water and detergent with paper towel.

Brooms should not be used in any healthcare area as they disperse dust and microorganisms into the air.




8.23.4 Hazardous substancesAs required by the Occupational Safety and Health Regulations 1996 and the National Code of Practice for the Preparation of Material Safety Data Sheets, any hazardous substance used or stored at this practice will have a corresponding Material Safety Data Sheet (MSDS). The MSDS provides information about the ‘hazardous substance’ and how it should be used and how to avoid harm when using it at the workplace. It must be written in English and contain the following information:

The identity of the chemical,

Health and physicochemical hazards,

Safe handling and storage procedures,

Emergency procedures, and

Disposal considerations.

This practice has a register which lists all hazardous substances used in this workplace with a current material safety data sheet (MSDS) for each of the substances listed.

It is the policy of this practice that staff members who are required to handle chemicals are trained in their correct and safe use. This includes the correct use of personal protective equipment (PPE).

All chemicals are stored in an area not accessible to the public.

Sources:

Hazardous substances. Western Australian Government Department of Mines, Industry Regulation and Safetyhttps://www.commerce.wa.gov.au/worksafe/hazardous-substances

Safety Data Sheets. Safe Work Australia.http://www.safeworkaustralia.gov.au/sites/swa/whs-information/hazardous-chemicals/sds/pages/sds





https://www.commerce.wa.gov.au/worksafe/hazardous-substances


8.23.5 Carpet1. Mop up as much of the spill as possible using disposable towels, and then clean with a

detergent.

2. Arrange for the carpet to be cleaned with an industrial cleaner as soon as possible.

8.23.6 General purpose areas – spot cleaning1. Don personal protective equipment (PPE) as considered appropriate.

2. Use disposable paper to absorb the bulk of the blood and body fluid.

3. Wash the surface with warm water and a neutral detergent.

4. Dry thoroughly with a clean wipe.

5. Dispose of waste in the infectious waste container.

6. If broken glass or any other sharp is involved it must be picked up with forceps and disposed of in a sharps container before cleaning and disinfection is attempted.

8.23.7 Treatment rooms – large spills1. Don personal protective equipment (PPE) as considered appropriate.

2. Cover the spill with paper towel and sprinkle/pour Sodium Hypochlorite (Sodium Hypochlorite solution is the usual agent used to decontaminate blood and body spills).

3. Leave the solution on the surface for a minimum of 10 minutes or until dry.

4. Clean the surface again to remove the chlorine.

5. Dry thoroughly.



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