Unit 10

The principles of infection prevention and control

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About this unit

In this unit learners are introduced to national and local policies in relation to infection

control. Learners gain an understanding of employer and employee responsibilities in

this area and how procedures and risk assessment can help minimise the risk of an

outbreak of infection. Learners will also gain an understanding of how to use PPE

(Personal Protective Equipment) correctly and the importance of good personal hygiene.

The learner will:

1. Understand own and other roles and responsibilities in the prevention and

control of infections

2. Understand legislation and policies relating to prevention and control of infections

3. Understand systems and procedures relating to the prevention and control of infections

4. Understand the importance of risk assessment in relation to the prevention and

control of infections

5. Understand the importance of using personal protective equipment (PPE) in the

prevention and control of infections

6. Understand the importance of good personal hygiene in the prevention and control of

infections

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1.1 Employees’ roles and responsibilities in relation to the prevention

and control of infection

Infection is a major cause of human suffering. Even relatively minor infections can

become more serious, leading to major infection and can, in some cases, lead to a

service user’s death. In addition to their suffering, infection causes distress to family and

friends.

The costs to the health care system of providing care for those with infections are

huge. In addition to concerns over the growing costs to health care, the use of

antibiotics to treat these infections is thought to be contributing towards the problems

surrounding antibiotic resistance.

The NHS plan, published in 1999, stipulates that all NHS organisations should have

effective systems in place to tackle Health Care Associated Infection (HCAI) in order to

minimise the risk to patients/service users and staff. The National Institute of Clinical

Excellence (www.nice.org.uk ) has a set of prioritised statements which are designed to

drive measurable quality improvements within health or care services. Prevention and

control of infections are issues of very great practical importance for every worker

responsible for the health of patients/service users. The Health and Social Care Act 2012

states clear expectation that the care system should considerthe NICE quality standards.

Your place of work will have appropriate guidelines/policies for control of infection and it is

important that you locate and read these and also visit the NICE website and look at the

standards - www.nice.org.uk/guidance/qs61/documents/infection-control-draft-quality-

standard2

Infection control is an issue of health and safety, so is both an employer and

employee responsibility.

An Introduction to Micro-biology

The immune system

The immune system, which is made up of special cells, proteins, tissues, and organs,

defends people against germs and microorganisms every day. In most cases, the immune

system does a great job of keeping people healthy and preventing infections. However

sometimes problems with the immune system can lead to illness and infection.

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The immune system is the body's defence against infectious organisms and other

invaders. Through a series of steps, the immune system attacks organisms and

substances that invade body systems and cause disease.

Employees’ roles and responsibilities

All employees are responsible for taking action to prevent the spread of infection, in

accordance with legislation and local and organisational policies and procedures. They

also have a personal and moral responsibility, as members of a caring society and

profession.

There are many roles where infection control is important, these include:

Employees who work in communal living environments

Employees who work with hazardous substances

Employees whose work activities may expose them to infection

Employees working with individuals who may be vulnerable to infection.

Employees have responsibilities to:

Self

Colleagues

Employer

Service users/Customers/Patients

Visitors.

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1.2 Employers’ responsibilities in relation to the prevention and control of

infection

Employers’ responsibilities arise from:

Legal responsibilities

Organisational responsibilities

Personal/moral responsibilities.

Employers’ are responsible for:

Assessing risks

Putting procedures in place

Ensuring procedures are followed

Ensuring employees are appropriately trained in relation to infection control

Making sure employees are aware of the health and safety aspects of their work

- Posting information on notice boards

- Keeping an information file such as Control of Substances Hazardous to

Health (COSHH)

Providing supervision

Keeping records

Ensuring that the relevant standards, policies and guidelines are available

within the workplace.

The Fundamental Standards for Health and Social Care providers state -

Safety - Service users must not receive unsafe care or treatment or be put at risk

of any harm that could otherwise be avoided. Risks must be evaluated during any

care or treatment pathway, making sure your staff have the qualifications,

competence, skills and experience to keep individuals safe

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Premises and equipment - The premises and equipment used for your care

service must be suitable, secure and looked after/used properly

Good governance - You must have sufficient governance and systems in place to

monitor the quality and safety of care and these must help the service improve and

reduce any risks to health, safety and welfare for your service users.

2.1 Legislation and policies relating to prevention and control of infections

Infection prevention and control guidelines and regulatory body standards

National good practice guidelines set standards and recommendations for all to follow.

An example is the guidelines of Infection Prevention Control in primary and community

settings, from the National Institute for Health and Clinical Excellence (NICE).

Legislation and regulations affecting infection prevention and control

The prevention and control of infection should be a high priority within the health related

setting for many reasons. Not least is the legal responsibility to have a duty of care.

In addition to Infection Prevention and Control Policies there will be other written policies

that interrelate with infection prevention and control and there are normally cross-

references to these in the Infection Prevention and Control Policies. These include:

Safe Handling and Disposal of Sharps

Decontamination Policy

Single Use Item Policy

Disposal of Waste Policy

Blood borne Viral Disease Policy.

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The Health and Safety at Work Act 1974 and Management of Health and Safety

at Work Regulations 1999

Both employers and employees are responsible for their own actions in the workplace. All

reasonable steps should be taken when carrying out your work duties and all staff should

have adequate health and safety training, and measures should be taken to ensure that

policies and procedures are in place and adhered to. For example, it is the employer’s

responsibility to provide adequate protective equipment and the employee’s responsibility

to use it appropriately.

The Public Health (Control of Diseases) Act 1984

Provides information on the legal requirements for the reporting of contagious or

infectious diseases, for example, Tuberculosis, Hepatitis, HIV and Legionella.

Health Protection Legislation Guidance 2010

The Department of Health has published updated health protection legislation covering

the recently amended Public Health (Control of Diseases) Act 1984. The amendment is

concerned with health protection powers and the requirements of laboratories and

medical practitioners testing human samples.

Food Safety Act 1990

The requirements of this act apply to any area where food is prepared, stored or eaten.

Control is required to ensure that the risks of any infection, as a result of bad handling of

food, are minimised.

Local and central government employ staff to inspect premises without any

advance notice. (Environmental Health Officers).

Food hygiene

In many health care environments, there may be infection control responsibilities under

the Food Safety Act 1990 and the Food Safety Act (General Food Hygiene) Regulations

1995. And subsequent amendments in the Food Safety Act 2005.

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Under this legislation, workers who handle food must:

Keep themselves and their workplace clean

Wear suitable clean, washable or disposable, protective clothing

Protect food from any possible contamination

Abide by regulations setting out safe temperature controls for storage,

preparation and display of food

Inform their employer of any illness which may affect their safe handling of food.

N.B. These regulations also require that employees who handle food as part of their

normal duties should also undertake specific food hygiene training.

Reporting Injuries Diseases and Dangerous Occurrence Regulations (RIDDOR) 2013

The employer or manager in control of work premises has a responsibility under RIDDOR

to report any work related accidents or disease which result in serious injury or an

employee being “off sick” due to injury for more than seven working days.

The Public Health (Infectious Diseases) Regulations 2001

This describes the reporting systems and the types of disease which must be reported.

Management of Health and Safety at Work Regulations 1999

Requires all staff to be provided with adequate and appropriate training and a set of

working instructions demonstrating ‘safe working practices' for work related

activities.

The Government has produced guidance published by The Health Protection Agency

(2013) ‘Prevention and control of infection in care homes - an information resource - you

may find this useful. It can be found at the following link -

https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/214929/Care-

home-resource-18-February-2013.pdf

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Controls Assurance Standards - Infection Control 2010

This standard provides a framework to control and manage infection. It provides a time

table for senior managers and infection control teams to work to.

The document’s key action areas are:

Strengthen prevention and control of infection

Secure appropriate health care services for service users with infection

Improve surveillance of infection

Monitor and optimise antimicrobial prescribing.

Medicines and Health Care Regulatory Agency (MHRA)

This regulatory body ensures the medicines and products available in the health care

sector are safe to use. The MHRA issue SAFETY BULLETINS if they receive reports of

faulty products or products which may be harmful to health. It is the responsibility of the

health care facility to report untoward incidents or products that are faulty to the MRHA.

Best Practice Guidance

In February 2013, the Government produced some best practice guidance for the

prevention and control of infection in care homes. This resource was intended for home

managers as well as CQC inspectors so that they might have a common source of

information on the subject.

This information resource was developed by the Department of Health (England) and the

Health Protection Agency in conjunction with the Care Quality Commission. It is

important to have clear information available for the families and carers as well as those

receiving the care, so that everyone can be reassured that care is provided in a safe and

clean environment.

This guidance should be read alongside the Code of Practice on the prevention and

control of infection and related guidance from the Department of Health 2010, as part

of the Health and Social Care Act 2008.

The Code sets out the criteria for registration as a care provider and all of the

infection control systems and processes that need to be demonstrated. However,

depending on the circumstances, not all of these will apply to every provider.

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The Health and Social Care Act 2008: Code of Practice can be seen at:

https://www.gov.uk/government/publications/the-health-and-social-care-act-2008-code-of-

practice-on-the-prevention-and-control-of-infections-and-related-guidance

Complianc

e criterion

What the registered provider will need to demonstrate

1 Systems to manage and monitor the prevention and control of infection.

These systems use risk assessments and consider the susceptibility of

service users and any risks that their environment and other users may

pose to them

2 Provide and maintain a clean and appropriate environment in managed

premises that facilitates the prevention and control of infections

3 Ensure appropriate antimicrobial use to optimise patient outcomes and to

reduce the risk of adverse events and antimicrobial resistance

4 Provide suitable accurate information on infections to service users, their

visitors and any person concerned with providing further support or nursing/

medical care in a timely fashion

5 Ensure prompt identification of people who have, or are at risk of

developing an infection so that they receive timely and appropriate

treatment to reduce the risk of transmitting infection to other people

6 Systems to ensure that all care workers (including contractors and

volunteers) are aware of and discharge their responsibilities in the process

of preventing and controlling infection

7 Provide or secure adequate isolation facilities

8 Secure adequate access to laboratory support as appropriate

9 Have and adhere to policies, designed for the individual’s care and

provider organisations that will help to prevent and control infections

10 Providers have a system in place to manage the occupational health

needs and obligations of staff in relation to infection

Other relevant legislation

Learners should have an awareness of legislation and standards as relevant to the

prevention and control of infection and the consequences of not meeting with these

requirements such as:

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Control of Substances Hazardous to Health(COSHH)

Guidance produced by the Department of Health, National Institute for Health and

Clinical Excellence (NICE), Royal College of Nursing(RCN).

The Environmental Protection (Duty of Care) Regulations1991

Health Protection Agency Bill2004

Hazardous waste regulations2005

The Food Safety (General Food Hygiene) Regulation (Department of Health,1995).

Other new/current legislation that affects infection control.

The responsibilities of the infection prevention and control team

Your organisation will have an infection prevention and control team or representative

(usually the home manager). The members of the team will vary between types of health

care environments, but:

They are responsible for training, education and advising on best practice for

infection prevention and control in your organisation

They are accessible to all staff for advice and guidance on all aspects of

infection prevention and control

The team/person is responsible for writing, implementing and renewing

policies and procedures in relation to infection prevention and control

practice.

Typical infection and prevention control team

The members of the Infection Prevention and Control Team will vary according to the size

of the organisation. In a large unit (Acute NHS Trust) the Infection Prevention and Control

Team will be headed up by a Director of Infection Prevention and Control (DIPC), a

Medical Microbiologist and Infection Prevention and Control Nurses (ICNs) who can give

you guidance on all matters relating to infection prevention and control. ICNs will often

cover specific areas, e.g. hospitals, nursing homes, GPs’ surgeries, and dentists. This

makes it easier to contact a named person and build up a good relationship.

Other sources of information

There is great deal of information regarding infection prevention and control available on

the internet. The Infection Prevention Society (IPS) is an excellent source of information.

Also the Health Protection Agency (HPA) and Health and Safety Executive (HSE)

provide valuable information on this subject, as does the Department of Health (DoH).

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Universal precautions

Universal precautions for the prevention and control of infection include the following

precautions:

1 Hand washing

2 PPE

3 Waste disposal

4 Sharps handling and disposal

5 Safe handling of body fluids

6 Cleaning and disinfection policy

7 Laundering of linen.

Further guidelines and regulations

Other current Government and/or Health Department standards and guidelines

Skills for Health Infection Control workplace competencies

Other national standards and regulations which are current.

2.2 Local and organisational policies relating to the prevention and

control of infection

In addition, there will be local and organisational policies and procedures which will

adhere to and reflect legislation and guidelines:

Health and safety policies

Organisational infection control policies

Any policies specific to role, industry or organisation, e.g. food safety in food related

areas.

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3.1 Procedures and systems relevant to the prevention and control of

infection

In the event that there is an infection outbreak, the nominated Infection Control

Personnel in your workplace will be responsible for notifying the appropriate authorities.

Notification may result in a visit from an Environmental Health Officer (EHO) employed

by the local authority. The role of the EHO is to protect people from environmental health

hazards in their living and working surroundings.

If there has been an infection outbreak, the primary aim of the EHO will be:

To identify the source of infection

To ascertain whether other people are likely to become infected

To provide advice on preventing further spread of the infection.

Measures must always be taken to reduce the risk of infection, and to minimise the

spread of an infection if an outbreak arises.

In the event of a member of staff becoming unwell there are strict guidelines regarding

when that person may attend work. Different infectious diseases can be passed on in

different ways. Most infectious diseases have what is termed an ‘incubation period’. This

is the time when the ill person is most likely to pass their infection on to another person.

The Infection Control Personnel will provide guidance regarding the absence required

from work, in order to minimise the risk of infection spread.

In some instances the ill person may have had contact with other people during the

incubation period, before they realised they were unwell. It is still important to know the

incubation period of a disease, in order to identify how many people may have come into

contact with the infected person, and to assess what the risk of infection spread is likely to

be.

Procedures and systems include:

Risk assessment (including use of PPE and personal hygiene)

Steps taken to reduce the chance of spreading infection

- immunisation, barrier nursing, food hygiene

Surveillance of disease via public health departments

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Organisational procedures

Safe systems of working

Health and safety management systems

Reporting systems.

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DISEASE INCUBATION PERIOD PERIOD OF

COMMUNICABILITY

MINIMUM RECOMMENDED TIME OFF WORK

MANAGEMENT OF INFECTION

Exclusion guidelines for staff, family and friends

The following table gives guidance on exclusion from work for the more common or important infectious diseases.

DISEASE

INCUBATION

PERIOD

PERIOD OF

COMMUNICABILIT

Y

MINIMUM

RECOMMEND

ED TIME OFF

WORK

MANAGEMENT OF INFECTION

Chicken Pox 15/18 days From one to two

days before and up

to five days after the

rash appears

Five days from

onset of rash

when the spots

are dry

Isolation nursing until spots are dry

Glandular

Fever

28/48 days Prolonged infectivity

but once the

symptoms have

subsided small risk

except from very

close contact

Until clinical

recovery

Personal protective equipment advised

Measles 10/15 days A few days before

to four days after

Four days from

onset of rash

Isolation nursing for up to four days from onset of

the rash

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onset of the rash

Salmonella 12/72 hours Whilst organism

is present in

stools but mainly

until diarrhoea

has ceased for

24/48 hours

Until diarrhoea

has ceased for

48 hours

Good personal protective equipment and also

limit use of communal facilities

Impetigo Usually 4/10 days but

can occur several

months after

colonisation

Until lesions are dry

or until 48 hours

after starting

antibiotics

48 hours after

starting

antibiotics.

Treatment is

rapidly effective

Personal protective equipment, towels should not

be shared. Observe other service users for signs

of infection

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3.2 Potential impact of infection outbreaks

Effect of infection on the individual

Causes pain and discomfort

Delays recovery

Disrupts and distresses family and the individual

Increases risk of serious illness and death

Unnecessary illness, in some cases leading to death.

Effect of infection on health related settings

Increased length of stay of individuals

Increased use of medication

Increased time and resources while cause investigated

More frequent and return visits by the individual

Disruption to routine

Cost

Cancellation of services and activities

Possible legal action

Loss of reputation.

Effects on Staff

Additional workload

Stress

Possible risk of infection to family

Policies and procedures not being followed effectively due to staff shortages.

EFFECTIVE PREVENTION AND CONTROL OF INFECTION will therefore minimise

the risk of infection meaning that patients/service users can be treated more effectively

and efficiently.

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4.1 Risk

Definitions of Risks and hazards

Hazard - something with the potential to cause harm, death, ill health, injury,

loss of production or damage to plant or property.

Risk - Can be described as the level of probability that someone or something

will be harmed because a hazard exists. This entails the likelihood of injury,

damage or harm arising, taking into account any preventative measures

already in place. A risk is any situation, activity or individual who has the

potential to cause the spread of infection to others.

For instance, a sharp knife left in a washing up bowl is a hazard, receiving a cut from

putting your hand in is the risk; a control measure is not to leave sharp knives in the

bowl.

In the context of a health related setting, the risk of being invaded by an agent

(bacteria, virus, fungi, or parasite) from an internal or external source would be

included.

Hazard identification

In order to achieve a suitable and sufficient risk assessment it is essential to

identify all the hazards associated with the activity.

Monitor work areas and working practices

The less formal way of identifying risks is to be aware at all times of what is going on

around you, and to encourage others to tell you about any risks that they identify.

You can examine the work area for safety and security risks and keep a check on

working practices such as:

Work

activities

Procedures

The use of materials or equipment

Working techniques.

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4.2 Potential risks of infection within the workplace

These risks include:

Risk of illness and death particularly in vulnerable individuals including:

- The very old (immune system is poorer)

- The very young (not yet developed properly)

- Pregnant women

- People with illness or health problem (certain drugs suppress the immune

system)

- People with severe burns

Risk to staff of illness especially those involved in high risk activities, such as:

Caring for/or treating those with infection

Contact with body fluids that may be contaminated.

4.3 Risk assessment

A risk assessment may be defined as an identification of the hazards present and an

‘assessment’ of the extent of the risk involved, taking into account whatever precautions

are already in place.

Health and Safety Executive (HSE) guidance

A risk assessment is simply a careful examination of what, in your work, could cause harm

to people, so that you can weigh up whether you have taken enough precautions or

should do more to prevent harm. Workers and others have a right to be protected from

harm caused by a failure to take reasonable control measures.

Where five or more persons are employed, that assessment must be

written down. There are ‘five steps to risk assessment’:

Identify all the hazards

Decide who could be harmed

Evaluate the risks and decide if existing control measures are adequate and

decide on precautions

Record the findings and implement them

Review your risk assessment and up-date if necessary.

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During risk assessment, any control measures to limit the risk will have been identified.

Further control measures may be applied following the assessment. It is your

responsibility to check and use risk assessments.

It is vital that before you begin work you check and use any risk assessments. This will

reduce risk and provide protection for all those involved.

The risk assessment process

Identify hazards

Assess risks

Eliminate risks where possible

Reduce risks where they cannot be eliminated

Recording the risk assessment process

Regular reviews of risks to ensure suitable controls are in place

Reporting outbreaks of infectious notifiable diseases

Risk assessment as a continuous process which is the responsibility of

organisations and individuals.

In order to implement effective prevention and control of infection measures within

the health setting employees should use a risk assessment approach. That is to:

1. Assess the risks

2. Decide what precautions are needed

3. Prevent or adequately control exposure

4. Ensure that control measures are used and maintained

5. Monitor exposure

6. Carry out appropriate health surveillance

7. Prepare plans and procedures to deal with incidents and emergencies

8. Ensure employees are properly informed, trained and supervised.

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4.4 The importance of carrying out a risk assessment

It is a requirement of the Management of Health and Safety at Work Regulations to carry out

and document risk assessments. Risk assessment is a proven way to control infection if

implemented properly by staff.

5.1 Demonstrating the correct use of PPE (personal protective equipment)

It is vital, to ensure effective infection control, that all staff are aware of not only the

types of personal protective equipment (PPE), but its correct use.

You must understand and be able to demonstrate when and in what circumstances you

should wear PPE. You should know which PPE to use and be able to demonstrate how

this is worn. This could include, for example, explaining the need to wear a disposable

apron and being able to demonstrate, by your actions, how to wear this correctly and

when it is appropriate to remove.

Disposal will be dealt with further in this unit.

5.2 Types of PPE

Personal protective equipment (PPE) is a term that covers all equipment that is intended

to be worn, or held, by employees and which protects them against one or more risks to

their health and safety.

Gloves

Gloves may be worn for many reasons but do not remove the need for effective hand

washing.

Gloves may be used as a barrier to prevent self-contamination when dealing with body fluids

or chemicals, or to protect skin lesions. They may be used after hand washing in aseptic or

sterile procedures. However, once removed they should be discarded into a clinical waste

bin and hands must be effectively washed and dried.

Gloves are disposable products and should be used for one task/procedure only.

Gloves should be non-powdered latex or vinyl material. However, latex-free or hypo-

allergenic should be made available for staff with latex sensitivity or allergy.

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Aprons

Although heavy contamination of clothing is not normally seen in most day to day

health related settings, the area at waist height is at most risk, so a plastic, disposal

apron affords good protection. Plastic aprons are waterproof and therefore helpful in

protecting uniforms from moisture during procedures which could involve liquid spillage.

Plastic aprons should be worn whenever there is a risk of bacterial contamination, for

example, during bed making, dirty jobs or isolation nursing.

Blue aprons should be worn in food preparation areas and white aprons in other areas.

An apron should be changed after every task/procedure/every service user contact,

between working areas or after contact with infected individuals.

Masks

Research studies have shown that masks contribute little to infection control in the

general health environment.

They provide protection from staff who have a respiratory infection. However, that member

of staff should be at home until such infection has cleared rather than increasing the risk of

infecting vulnerable individuals.

Micro-organisms are more likely to be spread by improper use of a mask, for example,

constantly touching it. For staff protection from specific contagious infections, procedures

should be in place involving the wearing of masks.

The wearing of a mask is important where there is an increased risk of splashing from

blood or other body fluids.

However, where masks are worn you must follow the guidance given in the organisation’s

infection control policy.

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Eye protection

Eye protection should be worn during all procedures where there is any risk of splashes or

aerosol spray involving blood or body fluids, e.g. suction procedures such as the taking of

blood.

Types of eye protection that must be available include goggles, visors and face shields.

These should be readily available in the workplace.

5.3 Reasons for use of PPE

PPE is used to protect the individual and others from potential risk of harm.

All users should follow all manufacturer’s instructions and recommendations for use and

should be aware and trained in specific items of PPE by their employer.

When PPE should be used

As recommended by your employer including:

When handling contaminated waste and linen

To prevent cross-contamination when handling food

To protect yourself and others from infectious diseases

To avoid injury, disease and illness.

5.4 Legislation and regulations

Legal requirement in health and safety legislation for the provision and use of

PPE where employees and others may be at risk

Regulations for the use of PPE in infection control.

Relevant legislation

The Health & Safety at Work Act1974

The Management of Health & Safety at Work Regulations1999

COSHH Regulations 2002 (as amended)

The Personal Protective Equipment at Work Regulations 1992 (as amended)

The Control of Noise at Work Regulations2005

The Construction (head protection) Regulations1989.

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5.5 Employees’ responsibilities regarding the use of PPE

To use PPE appropriately and as instructed by the employer

To check PPE before and after use

To report any damage or wear or other problems

To store in facilities provided for PPE.

Health related workers must wear personal protective equipment (PPE) while

performing some tasks to protect both themselves and their services users from

acquiring infection and to prevent cross-infection between individuals.

PPE should be worn when appropriate according to the organisation’s infection control

policy. However, health related workers must look at the task in hand and ascertain if it

could be carried out in a more effective way in order to reduce risk of cross infection.

5.6 Employers’ responsibilities regarding the use of PPE

Employers are obliged to provide, free of charge, any personal protective equipment

(PPE) that is required by you for the purposes of your job role and to provide training.

Your manager will be able to provide advice and guidance in respect of wearing

protective clothing, related to activities undertaken in your workplace.

5.7 Correct practice in the application and removal of PPE

In order to prevent the spread of infection, cross-contamination and re-contamination,

accidents and injury, it is vital that all staff know:

How to use PPE

The correct application of PPE

The correct removal of PPE

The appropriate PPE for work activity

Correct preparations for use.

5.8 Correct disposal of PPE

Appropriate disposal of single use items, e.g. in clinical/hazardous waste

where appropriate

Preparations of re-useable items for re-use, e.g. sending to the laundry

appropriately labelled in the correct colour-coded bag.

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6.1 The key principles of good personal hygiene

Personal hygiene

Personal hygiene is a very important factor in reducing the risk of infection in the workplace.

There are many other benefits from attending to personal hygiene, such as:

Comfort and relaxation

Warmth

A clean, odour-free and presentable appearance - this maintains self-esteem

and self- respect

Prevention of bacterial and fungal infections.

There are seven normal bodily functions that create the need for hygiene. They are:

Eating

Coughing

Elimination of

urine

Sweating

Drinking

Sneezing

Elimination of faeces.

These bodily functions will mean that certain parts of the body will require particular

attention to prevent discomfort, infection and unpleasant odours.

This will include:

The axillae (armpits) due to sweating - to prevent odours and fungal infections

The groin, pubic and perianal areas, due to sweating and elimination of urine and

faeces, particularly in patients/service users who are incontinent or catheterised -

to prevent skin and genitourinary system fungal and bacterial infections, skin

breaks or sores and unpleasant odours.

Oral hygiene and mouth care

The mouth and teeth require regular and thorough cleaning to reduce the risk of tooth

decay and infection caused by debris associated with eating and drinking. Neglecting

mouth care may result in, not only local infection, but a more generalised systemic

infection. Those who are frail, ill, vomiting or dehydrated will require monitoring and may

need help to attend to their oral hygiene to prevent soreness, fungal infections (e.g.

thrush), gum disease and tooth decay.

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Clothing

Organisations must have a personal hygiene policy outlining standards for dress and

personal appearance to ensure that staff maintain a hygienic, healthy and safe

environment for service users and themselves.

Uniforms must be clean and free from contamination. They must be regularly laundered at

high temperatures separate from other laundry. This will minimise infection from bacteria

which may be found in the material of the uniform.

Uniforms should only be worn within the workplace, as bacteria from outdoor

soiling, public transport or animals may contaminate uniforms worn on the way to

work.

Staff should change out of workplace uniforms before travelling home because of the risk

of cross- contamination from bacteria collected within the health care setting.

Nails

Nails should be kept short, clean and without polish, decoration or false extensions.

Nails harbour bacteria and the use of a single-use or disposable germ-free nailbrush

should be sought if dirt is ingrained under the nails.

Nail varnish or other decorations are sources of bacterial growth, and contamination of

others is possible if polish or decorations flake or fall off.

Hair

Hair should be kept clean and if long should be worn neatly tied back from the face.

Hairspray and other products should not be used as these can be an irritant to the service

user. Hair should not usually pose an infection control risk if these measures are followed.

Whilst it is not a legal requirement to wear hairnets or hats when preparing food, it is good

practice to do so in a health care environment.

Skin lesions

Any cuts or grazes must be adequately covered with a waterproof dressing. Further

advice must be sought from managers in cases of eczema, psoriasis or other skin lesions

and guidelines adhered to.

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Hair cover

Hats are worn in catering, pharmacy, operating theatres and sterile services departments. If

worn, they should cover the hair completely.

Shoes

Shoes should always be kept clean. For your own protection, you should ensure that

you wear shoes which protect all areas of the feet to protect from spillage of body

fluids. In certain environments specialist shoes and/or disposable shoe covers may be

used (e.g. in operating theatres).

Watches and jewellery

Watches and jewellery should not be worn. Rings and earrings harbour bacteria and do

not allow for effective hand washing. They are also dangerous while handling individuals.

Jewellery should not be worn as it can damage the skin of the service user.

Make-up

Make-up if worn should be minimal to reduce the risk of particles of make-up

falling onto individuals’ wounds as they are being dressed.

Health checks and vaccinations

When employed in a health related setting there are guidelines regarding the minimum

health criteria which must be met to be fit for practice. It is common for a health

screening, or some kind of health checklist to be completed on starting a new post, such

as screening for Tuberculosis (TB), and Rubella and Chickenpox immunity. Usual

requirements are for Hepatitis B, influenza and tetanus vaccinations to be completed and

up to date.

Personal and family illness

When working in a health related environment it is essential that you are fit to perform

your work safely, and effectively, without risk to your own or other people’s health and

safety. Therefore, it is important that workplace policies and guidelines on staff infection

and work restrictions are adhered to.

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Should you or your family be suffering from any kind of infection, advice should be sought

from your GP, Occupational Health Department and/or manager with regard to returning to

work. With regard to viral gastroenteritis infections many employers recommend that you

stay away from work for a further 48 hours after illness has ended to ensure that you are

free from infection. Some employers will ask for further health checks before allowing you

back to work in areas where your illness could put service users at increased risk. It is

important to remember that infections can be carried in the body for weeks after symptoms

disappear and it is important that these infections are not passed on to vulnerable people.

Absence reporting

When requiring time off sick from work it is necessary to observe sickness reporting

procedures and provide details of the nature of illness causing the absence. The

manager records this information in case it becomes significant information in a future

infection outbreak. Specimens may be requested to identify cause of illness or

infection, such as a stool sample in the case of symptoms of diarrhoea and vomiting.

Further guidance can be found on the following site - www.hse.gov.uk

6.2 Good hand washing techniques

Wearing of gloves and their proper disposal will be an important aspect of infection

control, but correct hand washing procedures play a major part in the battle against

infection. All health related organisations will have a hand washing policy in place.

The single most important and neglected aspect of the control of infection is attention to

the basic rule of frequent, and thorough, hand washing by all health care professionals.

Studies indicate that health workers have been observed to wash their hands 25% to

50% less than they should to ensure they adhere to the requirements of best practice.

This means that some workers may need to wash their hands twice as much as they

actually do.

Infection can occur as the health worker moves from one person to another or handles

different sites on the same individual (e.g. giving an injection after bed bathing).

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It is known, for example, that hand washing technique causes a significant reduction in

the carriage of pathogenic bacteria on the hands. This is easy to learn and can

significantly reduce the spread of infection in the health care environment.

The aim is to remove dirt, organic material and transient micro-organisms. Good hand

washing can reduce spread of infection through faecal-oral transmission, contact with

respiratory secretions (sneezing, coughing) and contact with saliva, urine, blood and all

other body fluids, and contact with inanimate objects (door handles).

How to wash hands

Duration of washing is important, not only for mechanical action but also to allow

microbial products sufficient contact time. Therefore, it is recommended that hands are

rubbed vigorously together for 10 -15 seconds, generating friction on all surfaces of the

hand and fingers.

It is vital that you are able to demonstrate to your line manager/tutor that you adhere to

good hand washing techniques.

6.3 Correct hand washing sequence

See Unit 06 - Health, Safety and Wellbeing, section 4.4 “The recommended method for Hand

Washing” for diagrams for the correct hand washing sequence.

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6.4 When and why hand washing should be carried out

The purpose is to reduce the risk of carrying infection on hands which could be a risk

to self or others.

Washing your hands using soap and water is the single most effective

measure in the prevention of infection.

When you wash your hands you must choose the correct method of hand washing by

considering:

What you have just done

What you are about to do.

There are three types of hand washing:

Routine hand washing using soap/detergent/alcohol gel

Disinfectant hand washing using antiseptic soap/alcohol gel

Aseptic hand washing using surgical hand scrub.

(N.B. Bar soap is not recommended for use in communal settings as bar soap can

harbour harmful bacteria.)

Gels are not necessarily a good substitute for thorough hand-washing.

Routine hand washing

Routine hand washing should be used:

After using the toilet

After handling laundry or waste

After handling any patient/individual

Before and after preparing, handling or eating food

Before and after giving medication

Before and after removing gloves

Before starting work or after leaving work area

After bed making

When hands become visibly soiled

After touching animals

After handling any equipment that may be soiled.

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Some of the situations detailed previously such as handling laundry, wastes, and soiled

equipment should be carried out using protective gloves.

Rubbing hands vigorously with soap and water causes mechanical friction pulling dirt

away from the skin and into a dirt/soap suspension which can then be rinsed under

clear running water.

Disinfectant hand washing

Disinfectant hand washing should be used:

Before carrying out aseptic procedures

Before and after caring for patients/service users in isolation

Before and after handling open wounds, urethral catheters and IV lines

After handling equipment contaminated with body fluids

Alcohol gel may be used as an alternative to the above if there is no access to

soap and water when hands aren’t visibly soiled.

Aseptic hand washing

Aseptic hand washing should be used:

Before appropriate invasive surgical procedures or urinary catheter insertion

Before wound dressing.

Surgical hand wash is a broad spectrum, fast acting, persistent and non-irritating

preparation containing anti-microbial ingredients designed to significantly reduce the

number of micro- organisms on intact skin.

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6.5 Types of products used for hand washing

There are many products available for hand washing, including antibacterial soaps and

hand gel (gels do not replace hand washing but can be used when soap and water are

not available and until hand washing takes place).

6.6 Care of the skin

Frequent hand washing may cause skin problems, especially if hands are not dried

properly or the skin is not moisturised with approved hand creams. This can lead to hands

becoming chapped; cut, grazed or open wounds developing. Allergies to hand washing

preparations and gloves sometimes occur and must always be reported.

Skin lesions

Any cuts or grazes must be adequately covered with a waterproof dressing. Further

advice must be sought from managers in cases of eczema, psoriasis or other skin lesions

and guidelines adhered to.

Conclusion

The information you have read within this unit should increase your knowledge and

understanding, which will benefit you, the individuals you care for, key people and others.

Now complete the assessment questions for this unit in the workbook section.