Infection Control

1. 1 Explain employees’ roles and responsibilities in relation to the prevention and control of infection Within the last few years it has been highlighted that there is a very high increase in service users contracting healthcare related infections. It is therefore important that I take full responsibility to ensure that I take all the necessary precautions to prevent myself, service users and the general public that I come in contact with to take care of health and safety. The Health and Safety at Work 1974 requires me as an employee to:

Ensure that I take full responsibility to safeguard my safety and those of others Work closely with the Hospital I work in respect of health and safety issues Do not destroy any equipment in relation to health and safety intentionally Go on as many training courses provided by the hospital Make sure that I use protective garments that the hospital provides i. e. gloves and aprons at all times. Prevention is better than cure and try and take every opportunity to make sure that all infections etc be kept under control I also follow these Basic controls measures: Dispose of waste correctly Wash hands when appropriate

Keep equipment clean Remain vigilant and report potential hazards Wear clean PPE (personal protective equipment) for each person Maintaining personal hygiene. It has been identified by the Government that every year around 5,000 service users die from infection related diseases. So in this respect it is better to try and prevent infections by initiating the procedures set in place by the hospital to prevent loss of lives and also law-suits. Prevent infections by disposing waste, washing my hands after assisting each and every individual, keeping all equipment clean and sterile, observing any signs of hazards and wearing PPE.

All concerned at the hospital are considered “at risk” so I must follow procedures to prevent and control infections within the maternity ward. 1. 2Explain employers’ responsibilities in relation to the prevention and control of infection The Health and Safety Legislation requires and places a duty of care on the employer to protect employee. Employers will ensure: A safe working environment for employees Carry out regular risk assessments to avoid dangers at designated work environments Hold training courses for all individuals Issue PPE Monitor regular health and safety checks

Provide infection prevention and control policies and procedures Provide relevant equipment to enable employees to prevent and control infection Identify and distribute relevant information about infection hazards and prevention and control methods Keep records relating to infection prevention and control in organization My employer must make sure that they take responsibilities for my protection and those of service users in relation to contamination of blood relation infections, body fluids. There are rules and regulations set in place within the NHS that has to be observed.

The North Middlesex Hospital will be able to cope in the event of infection outbreak this includes taking the necessary steps to swabs and also to isolate service users as and when necessary. In residential homes it is to the advantage of the manager to initiate regular cleaning to ensure that infections are kept at bay. Follow procedures in relation to washing of hands and also should an infection outbreak be recognised, relevant steps should be taken including information the Public Health Department. 2. 1Outline current legislation and regulatory body standards which are relevant to the prevention and control of infection

The Health and Safety at Work Act 1974: Sets standards to prevent infection occurring and spreading. It places a duty of care on me of the duty and care that should be adhered to protecting each and every individual on the premises. There is an extension to the HASAWA regulations that also covers the prevention and control of infections. Control of Substances Hazardous to Health (COSHH) 2002 The above regulation covers all dangerous materials that the hospital is likely to use such as: cleaning substances and disinfectants.

Reporting of Injuries, Diseases and Dangerous Occurrences Regulations 1995 (RIDDOR). The RIDDOR Regulations has stipulated that my employer is obliged by law to log and report all accidents which happen at work. These records stored for three years ready for inspection whenever required by the Health and Safety Executive (HSE) The following accidents that should be reported to the HSE: Death or major injury Poisoning Lung disease such as asbestosis Occupational cancers The Department of Health also introduced the Health and Social Care Act 2008.

This Act was set in place to ensure the Care Quality Commission (CQC); this superseded the Healthcare Commission, the Commission for Social Care Inspection (CSCI) and the Mental Health Commission. This was set to achieve a lot of improvements in the care that is to be afforded to the service users. Another aspect of this particular function is for the protection of all concerned albeit patients, workers and visitors. Public Health (Control of Diseases) Act 1984: Set standard for sanitation, water supply and disposal of rubbish Food and Safety Act 1990: Concerns food productions and consumption

Environmental Protection Act 1991: Ensures the safety management (handling, transfer, and disposal) of controlled waste. Management of Health and safety at work Act 1999: Introduced risk assessment The Public Health (Infection Diseases) Regulations Health Protection Agency Bill 2004 Other new / current legislation that affects infection control Hazardous waste regulations 2005 The food safety (General Food Hygiene) Regulation (Department of Health 1995) Regulatory body standards: NICE: guidance for NHS and local authorizes produced by the National Institute for Health and Clinical Excellence (NICE) Universal precautions

Other current government and / or Health Department standards and guidance Skills for Health Infection control workplace competencies Other national standards and regulations that are current National Occupational Standards (NOS) for health workers produced by skills for health Essential standards of Quality and safety 2010 including eight cleanliness and infection control measures, produced by the Care Quality Commission (CQC). 2. 2Describe local and organisational policies relevant to the prevention and control of infection The North Middlesex Hospital has set in place relevant policies and

regulations in relation to HASAWA to adhere to in connection with prevention and control of infection. These are included in the policies: Main key operatives in the field appointed to execute relevant duties within the prevention and control of infections with the NHS Means of ascertaining best methods of hand washing Appropriate hygiene needs Preventative measures Appropriate times when to use PPE Usage and disposal of sharps Usage and disposal of clinical waste How to handle body fluids and blood Re-sterilizing instruments Keeping a sterile environment Proper procedure of recording and reporting accidents

Hand washing: I follow this procedure every single day, as soon as I get into the maternity ward. Appropriate times when to use PPE: I then use the rub some of the antibacterial gel followed by putting on my gloves and my apron. For each service user that I attend to I end up washing my hands and using new gloves and apron, so that I avoid cross infection. Usage and disposal of sharps: These are packaged and sealed in date and fit for use. They should be disposed of in the relevant bio-hazard bins Handle body fluids/blood: I always wash my hands followed by wearing a new pair of gloves and apron.

Take the above to the sluice room and dispose of in the sluice and wash down. Proper procedure of recording and reporting accidents: There is an accident book in the main office whereby all accidents are logged with all relevant information of how the accident took place, why, injury sustained, date, time, signature together with a witness statement if witnessed. The information should be written down as accurately as possible. Follow procedure in relation to (RIDDOR) Most of the above policies would seem appropriate for the environment that I work in and it would prevent and control infections if followed correctly and appropriately.

3. 1Describe procedures and systems relevant to the prevention and control of infection Infection range from mild to very serious, and can be fatal. They can be localized or systemic and are identified by signs and symptoms. Hence, there is the need for: All round daily cleaning keeping germs at bay Using chemicals to disinfect Keeping equipment sterile at all times Cleaning: There are a couple of cleaners on the ward assisting to keep all areas of the ward clean by disinfecting, washing the floors, wiping down bed frames corridors kitchen equipment washed daily e. g.

water jugs, keeping the toilets and bathrooms cleaned after every several hours signing and inserting dates and times. Making of beds and disinfecting them whenever a service user is discharged so that the bed is infection/germs free for the next service user. Using chemicals to disinfect: As mentioned above the cleaners clean, wash and disinfect toilets and bathrooms at regular intervals each and every day to eliminate the presence of germs that spread and cause infections. Sterilization: This process will kill all micro-organisms. In the operating theatre all the equipment that is normally used has to undergo the whole

process of being sterilized to prevent infection. The sterilization process will take place only after debris, blood or tissue has been removed from the said instruments. For example feeding tubes will also has to be sterilized for further and future usage. The main three ways of sterilizing in the medical section: (a) Autoclaving – most commonly used and the method of steaming are used. (b)Chemicals – used for sterilizing equipment (ethylene oxide gas) operation only taken by experienced individuals (c) Gamma radiation for usage in single items that cannot cope with high temperatures. 3.

2Explain the potential impact of an outbreak of infection on the individual and the organisation An infection can have a significant impact on an individual’s life. ‘Prevention,’ they say, ‘is better than cure. ’ The following are some of the detrimental effects of infection systems and procedures are not adhere to: Individual staff may call off sick and this can affect the quality of care provided Unnecessary illness which in some cases lead to death Distress to staff, individuals, family and friends Disruption to staff routines Reduce mobility Cause financial loss Disruption to routine

Cancellation of services and activities Possible legal action Loss of reputation 4. 1Define the term risk Risk is any situation, activity or individual, hazard which may cause the spread of infection to others. Pathogens can be present anywhere. Risk, or the chance of infection developing, is higher where the conditions are suitable for pathogens to multiply and be transmitted to others. Being microscopic, it is impossible to know which area, objects or people are contaminated. For example, a virus may needs a host body in order to multiply, and cannot survive for log outside the body it invades.

Similarly, bacteria need the following conditions to flourish. – Nutrients (broken down from deceased animals, plants, excreta, soil) – Moist conditions – Warmth – Oxygen, or no oxygen – depending on type of bacteria – Time – for cell division to take place. 4. 2Outline potential risks of infection within the workplace The potential risks of infection in the hospital that I work is greatly accelerated for the simple reason that I work with service users who are ill and their immune systems are low. These individuals are more vulnerable so I need to ponder on the following: The service user (The person being supported)

Myself – the worker The staff Equipment Relatives, families and visitors The environment The service user receiving support is almost certainly at risk of contracting an infection for these reasons: Age: both old and young service users are vulnerable and have poor immune system and can very easily come into contact with infections. Immune status: service users who have low immune status especially those who have been diagnosed with cancer and have been treated with chemotherapy are automatically considered as being high risk and more likely to catching infections.

This happens because they are very weak and cannot fight infections because their immune system is very low. Nutritional status: Individuals who have poor eating habits or cannot afford to purchase good nutritious food containing all relevant vitamins etc. are also at a high risk of catching all sorts of infections because their systems are very weak. Skin integrity: People who have been admitted in hospital following accidents, open wounds, undergone surgery. These people have an increased risk of infection. Invasive therapy: The skin may also be breached because of invasive therapies.

These invasive therapies give micro-organisms a direct route into the body. Drug therapy: People taking antibiotics can be at increased risk of acquiring an infection because the antibiotic can alter the level of normal bacterial living within the body. People receiving care who have highly contagious blood-borne diseases such as Hepatitis B or HIV or they have MRSA, so it is important to remember to treat all people as high risk and use standard precautions when providing care to people. Relatives, friends and visitors: They can also be at risk of infections when visiting the hospital.

Should there be an outbreak of a certain infection on the ward and this is contagious then obvious that they will come down with the relevant symptoms. On the other hand if the relatives or friends come to visit their loved individuals in the hospital and they have for example a chest infection, then they could quite easily pass this on within the ward or spread it when they leave the hospital. The Environment: The environment where people are being cared for and where I work must be kept as clean as possible.

Bacteria can live in damp environment. I have to pay attention to the bathroom, toilet, door handles and work surfaces, including where food is served or prepared. Bed frames and mattresses need to be cleaned on a regular basis. Equipment: That is non-disposable, such as surgical instruments, pumps, commodes and so on must be cleaned and disinfected after use and if appropriate sterilized. I, the worker: as an individual, I may also come in contact with infections whilst in contact with my colleagues at work. This may include: Colds Flu

Diarrhoea I am at risk in the workplace because deal with all sorts of ailments whilst supporting service users. I deal with items such as body fluids, blood that are considered to be very risky in catching hepatitis and HIV. Or scabies which is contacted by touch. Infections can be caught by air borne such as tuberculosis or swine flu. Prevention is always essential by following the relevant policies and procedures . All equipment should be cleaned by washing off blood, body fluids or tissues before proper sterilization takes place. 4.

3Describe the process of carrying out a risk assessment In relation to risk assessment the HSE has put in place a five-step guide: Identify the hazard: This would involve inspection of hospital, communicating with employees in relation to the activities that are taking place especially areas and situation where pathogens thrive. For example people working in the operating theatre are at the higher risk of infection. Decide who might be harmed and how: Each and every individual whether a nurse, doctor, patient or visitor will need to be considered as potentially at risk.

Evaluate the risk and decide on precautions: Identification of the biohazards needs to be researched and a decision made on what action to take to lessen it or eradicate the dangers. Standard precautions should be in place including PPE and cleaning process. One should ascertain whether or not the process in place is sufficient or needs to upgrade. Record the findings and implement them: All the information that has been processed through the risk assessment must be logged and elaborate on ways to control/prevent risks.

Enlighten care workers of the findings. Review the assessment and update if necessary: Each and every risk assessment must at all times be examined and revised as and when necessary for example if new PPE should be made available. 4. 4Explain the importance of carrying out a risk assessment According to Health and Safety Act 1974, organizations have a legal responsibility to protect the health and safety of employees at workplace. A risk assessment is one of the most important assessments to protect employees and organization’s reputation.

The assessment identifies the risks in the work place and the measures put straight forward measures can be put in place to control the risks. For example, PPE should be available to be used by everybody. Failure to undertake a risk assessment is not only illegal, but it also risks the health and safety of all people with in workplace. 5. 1Demonstrate correct use of PPE Within the hospital environment provision is made for me to be protected against infections with the following items: Gloves, Aprons.

These equipments are issued to each and every care worker, nurses, doctors, cleaners, theatre operatives, maintenance, as well as kitchen workers. This helps me to work efficiently and with confidence knowing that protection is in place to prevent spread of infections to not only service users but for all my colleagues within the maternity ward. The uniform I am issued with is a T-shirt with a logo stating “Maternity Ward Volunteer” to identify that I have clearance within that department to safeguard new born babies. PPE is an effective barrier when it is used correctly.

Most items are disposable and designed for single use. If I repeatedly use the same item of PPE, it become an infection hazard and ceases to protect against infection. PPE is used to cover areas of the body that can be both routes for pathogens to enter the body and cause infection. PPE also protects against pathogens that are present in the air, on skin, on objects and in fluids and which can be passed from person to person and person to objects. The main steps for correct use of PPE: First wash my hands before using PPE Select the appropriate type of PPE for the task Make sure PPE is intact and undamaged

Make sure PPE fully covers the area intended Remove PPE immediately following use Dispose of PPE into the appropriate waste stream Wash my hands after disposing of PPE The following are some of the PPEs: Masks: In the hospital environment masks are usually used especially in the operating theatre where open wounds and cuts tend to attract infections so these are used to prevent risk of infections Visors: These tend to be worn to sometimes protect the whole face preventing splatter of blood or body fluids Goggles: These are worn to protect the eyes from blood and body fluids being splatters perhaps during operations.

Hats: Hats are worn in most cases in the operating theatre to keep hair in place so that this does not get in the way. Shoes: Shoes are not provided for the work I carry out, but they must be low and very comfortable so that I can walk freely in my memory foam trainers. 5. 2Describe different types of PPE Plastic Aprons: Cover clothes or uniform. Made from slippery plastic, it is harder for pathogens to stick. It protects me from body fluids and to be worn during other tasks that hold a risk of bringing me into contact with pathogens. E. g.

: toileting, washing, giving oral care, administering suppositories, doing dressings. Plastic or latex gloves: protection for hands and nails, which are the main way pathogens are transmitted. E. g. : Preparing and serving food, cleaning spillages, obtaining specimens, emptying catheter bags, disposing rubbish. Paper masks: To cover mouth and nose, which are key sources of pathogens, as well as routes for pathogens to gain entry into the body. E. g. : tasks making me proximity to a source of infection, such as a wound. Cloth or paper gowns: Provide a complete covering for the body and can be used with plastic aprons on top.

E. g. : In areas where there is a need for sterile conditions, such as operating theatres. Plastic over shoe: Worn over normal shoes to prevent pathogens from outside being brought into clean areas. E. g. : where there is the likelihood of splashing with body fluids, such as when assisting with childbirth. Paper hair-cover: Cover head to prevent stray hairs escaping. E. g. : Handling, preparing, cooking and serving food. Plastic goggles: Completely cover eyes, including fitting over glasses. 5. 3Explain the reasons for use of PPE

The reason behind wearing personal protective equipment is to ensure protection for both parties the service user and the career. Uniforms: These are issued so that they reduce the risk organisms being taken from outside of the hospital onto the career to be further transferred to the service user. To prevent transference of infections from patient to career and vice-versa. It is important not to for example go shopping in my uniform. Gloves: Gloves are worn, so that they form a surface that does not come in contact with service user’s skin or any other outside surface in so preventing any form of infection.

In this respect there is the prevention of infection between service user and career. Apron: This will also protect me from making direct contact with service user or any other surface that could cause the risk of infection. In the hospital I am issued with white aprons. 5. 4State current relevant regulations and legislation relating to PPE There is a legal obligation for my employer to follow the regulations set out in the Health and Safety at Work Act 1974, stating that if personal protective equipment is required then these should be issued without any costs being incurred to me.

The onus is not on the employee to provide for personal protective equipment as this is a necessity needed for me to carry out my duties. In relation to the Health and Safety at Work Act 1974, there are certain regulations that are aimed at specifically mentioning PPE and these are as follows: Personal Protective Equipment at Work Regulations 2002 Management of Health and Safety at Work Regulations 1999 Control of Substance Hazardous to Health Regulations 2002 (COSSH) All of the above regulations are there to ensure that where risks can’t be prevented by other methods, then PPE is carefully selected and used.

The onus is on all employees to ensure that under the Personal Protective Equipment at Work Regulations that has been provided by my employer will be used properly and for the purpose they are intended. The Management of Health and Safety at Work Regulations 1999 is also set in place to allow employees to spot and check out the risks to health and safety in the work environment. Each and every risk must be reduced to an extent that is reasonably feasible. When a risk poses itself it is always advisable to lessen the risk by observing and wearing the PPE.

New regulations also stipulate that PPE equipment should reach a required standard set out – 1 July 1995 all equipment must be CE marked. This means that it meets with the European Union (EU) basic safety standard requirement. 5. 5Describe employees’ responsibilities regarding the use of PPE In the Health and Safety at Work Act 1974 Section 7 has placed the onus of responsibility on the employees to ensure they take care of themselves and those they employ. It is also my duty to include the use of PPE which I must wear. Failure to do so may entail disciplinary action.

The following requirements are my responsibilities: Training will be provided by my employer relating to the use of PPE which I must attend Proper use of PPE in relation to the appropriate training that has been proved by my employer Using all PPE properly that has been provided by my employer Putting all PPE back in the correct places after I’ve used them Should there be any damage or malfunction of a PPE I will report this to the house keeper as soon as possible. 5. 6Describe employers’ responsibilities regarding the use of PPE

As stated in the Health and Safety at Work Act 1974 employers have a duty to make sure that the safety and welfare will be maintained for their employees in the work environment. The will also undertake to ensure that under the Personal Protection Equipment at Work Regulations 2002 they will add these requirements: Check and assess the requirement for PPE check PPE to make sure that they are acceptable. Making sure that the equipment provided suffice to the purpose that they have been issued to comply with. E. g. – aprons that have been

provided are adequate for usage when a baby vomits whilst I am winding the baby this spillage goes onto the apron and not directly onto my shirt. The company will provide all PPE to employees free of charge and should under no circumstance ask for payment unless the employee has decided to leave the organisation and does not return a particular item of PPE. In this other, the employer has the right to ask for a refund to obtain new PPE. This request should be made crystal clear within the contract that has been agreed between the two parties. Provide training, instruction and notices about PPE

Carry out risk assessments to inform decisions about appropriate PPE Ensure PPE is being used and used properly 5. 7Describe the correct practice in the application and removal of PPE PPE Items To Apply To Remove To Dispose of Gloves and aprons Wash hands before use Put on gloves and apron before starting the procedure. Change gloves and aprons between caring for different service users and between different care tasks for the same service user. Remove as soon as the procedure s complete. Take off carefully and in such a way that my hands and clothes/uniform do not have contact with any substances contaminating the glove or apron surface.

Gloves are for single use only and must be disposed of after removing. Dispose of as clinical waste. Do not touch the bin with contaminated gloves or hands – where possible operate with a foot pedal. Wash hands with soap as soon as gloves/ aprons are disposed off. 5. 8Describe the correct procedure for disposal of used PPE The non-disposal items of PPE need to be cleaned, decontaminated made to dry and stored in relevant designated places that the organisation has set aside for. Disposable/clinical waste such as gloves aprons and hats are considered to be very high risk material and should therefore be disposed of to avoid cross-infection.

If for some reason I have accumulated clinical waste in my home this can only be disposed off in the correct manner and should not be put in normal black bags for disposal on land filled sites The Hazardous Waste Regulations 2005 has legal implications set out for example the NHS in the way in which hazardous garbage has to be registered with the Environment Agency. In the year 2006 the Department of Health Environment Agency has put in place the Safe Management of Healthcare Waste which in league with the European colour coding for waste products. These are set out below: Orange denotesinfectious waste

Yellowinfectious waste that needs to be burnt Purplecytotoxic this also needs to be burnt Yellow/blackoffensive waste that needs to be transported to licensed depots BlackThis is similar to the yellow and black procedure. 6. 1Describe the key principles of good personal hygiene Personal hygiene is a private matter, but when I work in a care setting I have a professional responsibility to maintain a regulated standard of personal hygiene which is set out in a personal hygiene or infection control policy. Bathing and showering: Regular bathing or showering prevents the spread of bacteria, and reduces body odour.

Hair Care: Regular hair washing prevents the spread of bacteria. Long hair need to be tied back. Some care environments bring me into contact with head lice which infest clean hair as readily as dirty hair. Regular brushing with a fine-toothed comb helps to prevent this, but in the event of an infestation, need consult with pharmacist for advice about treatment. Oral Hygiene: Good oral hygiene and six monthly visits to the dentist will prevent the build-up of bacteria and reduce halitosis (bad breath). It is especially important to brush following meals or after smoking.

Hand and Nail care: Hand and nail care is vital in preventing and controlling the spread of infection. Clean clothes: Clean work clothes are an important aspect of personal hygiene, and should be changed daily, even when covered by plastic aprons. While working. Uniforms are made of hard-wearing materials that launder at high temperatures to remove most pathogens. Cutting out certain habits: Smoking, which involves putting my hand to my mouth and increases the likelihood of coughing. Touching the face, especially nose mouth and ears, which are routes for infection. Nail biting, which can produce sores and risks spreading infection

Sneezing and coughing without covering the mouth, not disposing of tissues properly, and not washing hands afterwards. Taking Care of Health: Good personal hygiene practice is bolstered by a healthy lifestyle, which helps both avoid and fight off infection. Sleep refreshes and renews my body. Good nutrition keeps my body and brain process working well. 6. 2Demonstrate good hand washing technique Washing of hands is very important in reducing the risk of infections. Yet this practice is not being undertaken by most care workers this is why infection and cross-infection tends to multiply and is being passed on to and from other service users.

There are three stages to a good hand washing technique: preparation, washing and rinsing, drying. Preparation: Check sink and taps to ensure these are clean before use. Check equipment to ensure there is soap, towels or a hand drier available. Remove jewelry, which harbors pathogens and may prevent me washing thoroughly for fear of damaging them. Roll sleeves up to expose wrists and forearms. Run water to a warm temperature as uncomfortable temperatures reduces time spent washing hands.

Washing and Rinsing: There are a number of important factors to consider when washing and rinsing my hands. Preferably use running water. Wash hands thoroughly before using soap. Soap hands, making sure the solution come into contact with all areas. Rub hands together vigorously for a minimum of 10-15 seconds, paying particular attention to the tips of the fingers, the thumbs and the areas between the fingers. Rinse hands thoroughly. Drying: It is vital that hands are dried thoroughly. Ideally use a hot air drier, and continue using until hands are totally dry.

Alternatively, use paper towels, discarding them without touching the bin with hands 6. 3Describe the correct sequence for hand washing There is a specific correct sequence for hand washing to be followed and these are: Take off my watch and rings Choose the correct temperature of water that is comfortable Wet both hands Put a full measure of hand wash liquid and rub palms of hands together Rub one hand over the other one and do not forget the gaps between each finger Ensure that rubbing of the finger tips in a round action against the palm of the other hand and then change.

Entwine the thumbs making sure that the thumbs and the wrists have been well coated with washing soap When the washing of the hands is complete, make sure to rinse to take out any remaining soap Should the hands need to be washed for a specific activity then it is advisable to repeat the procedure in bullet point 4 and 9 Close the taps with elbow Make sure that hands are completely dry using absorbent paper towel. 6. 4Explain when and why hand washing should be carried out It is normal practice usually to adopt the policy of hand washin