Last reviewed 3 July 2018
Martin Hodgson investigates the 10 hygiene and infection control priorities for primary care services.
1. Every general practice must have an appropriate infection control policy in place which is implemented in full and subject to regular monitoring and review.
The policy should be based on best practice and should cover all aspects of infection control management and prevention, including:
effective handwashing and decontamination
cleaning the premises
procedures for the cleaning of spillages
sterilising instruments and equipment
handling and disposing of clinical and soiled waste
use of protective clothing
handling and storing specimens
sharps safety (eg used syringe needles)
staff health and immunisation.
All staff should be made aware of the contents of the policy.
The policy should name an individual to be the practice lead for infection prevention and control. This should be someone with appropriate knowledge and skills.
You can find a template Infection Control policy here, which you can adapt for your practice.
2. Every practice should have effective cleaning arrangements in place.
The practice should be covered by a cleaning schedule that defines how often different areas will be cleaned. For instance, a typical schedule might include:
daily requirements, eg the daily emptying of rubbish bins, cleaning of clinical and treatment areas, toilets, washrooms, waiting rooms, kitchens, etc
weekly requirements, eg the vacuum-cleaning of all carpets
monthly requirements, eg the deep cleaning of sanitary ware (toilets and urinals) and clinical areas.
Arrangements should include set standards and a method of recording activity.
The cleaning regime should ensure that practice premises are kept in a clean and hygienic condition at all times, particularly toilets and clinical treatment areas. Standards should be carefully monitored and any shortfalls addressed. Clinical areas will need additional decontamination as appropriate.
Cleaning schedules should be enhanced in the event of an outbreak of infection. Contingency plans should be developed with cleaning staff covering how increased levels of environmental cleaning can be accomplished.
3. Encouraging good personal hygiene by regular, effective handwashing and drying. When done correctly, is the single most effective way to improve hygiene standards and prevent the spread of diseases.
Effective hand hygiene is a key element in infection prevention and control. All primary care services should have robust hand decontamination policies and procedures in place which comply with best evidence-based practice, such as the World Health Organization Five Moments for Hand Hygiene framework. These should be supported by the provision of appropriate facilities, equipment and training.
See a useful table for handwashing and drying best practice here.
Key times for staff to wash their hands include:
between seeing each and every patient where direct contact is involved, no matter how minor the contact
before clean or aseptic procedures
after handling any body fluids or waste or soiled items
after handling specimens
after using the toilet
before handling foodstuffs
after removing disposable gloves.
To enable effective handwashing, practice managers should ensure the provision of adequate facilities. There should be enough sinks which:
are clean and easily accessible
have robust, easy-to-use dispensers for liquid soaps
have a supply of disposable towels.
Hot water should always be available.
Liquid soaps are preferred to bar soaps, which can rapidly become soiled and provide just the sort of damp environment in which micro-organisms will proliferate.
Disposable paper towels are preferable to the use of linen towels which, like bar soaps, can become soiled and damp. Thorough drying of the hands should be encouraged.
Foot-operated waste bins should be provided for used towels. All equipment for hand decontamination should be regularly cleaned and maintained and liquid soaps and paper towels replaced when empty.
Handwashing reminders and posters can be posted by sinks.
Guidance on hand decontamination is set out in CG139: Healthcare-associated Infections: Prevention and Control in Primary and Community Care produced by the National Institute for Health and Care Excellence (NICE).
4. Where necessary, handwashing should be supported by the use of alcohol hand rubs.
Alcohol rubs, antibacterial gels or hand sanitisers can be used as an additional element in hand decontamination to prevent the spread of infection.
NICE guidelines state that alcohol hand rubs conforming to current British standards should be used except in the following circumstances, when liquid soap and water must be used:
when hands are visibly soiled or potentially contaminated with body fluids (in which case hands should be thoroughly washed and dried first)
in clinical situations where there is potential for the spread of alcohol-resistant organisms (such as Clostridium difficile or other organisms that cause diarrhoeal illness and are unaffected by alcohol rubs).
To use a rub:
ensure hands are free from dirt and organic material
do not wet hands
dispense enough of the rub into the palm of the hand
spread the rub thoroughly over both hands
rub vigorously until dry.
Importantly, the use of alcohol rubs are not intended to replace washing hands with soap and water but rather as a supplement where extra decontamination is required or where hygienic handwashing facilities are unavailable.
5. Practices must ensure the provision and use of appropriate personal protective equipment, especially disposable medical gloves.
The use of disposable medical gloves is often indicated in delivering care and treatment. However, it is important that good hand hygiene procedures are followed before putting gloves on and immediately after taking them off. Disposable gloves should be discarded after use and hands should be washed and dried following removal.
Clinical staff should ensure that they use a new pair of gloves for each new task, even if performed for the same patient.
Disposable gloves are an important element in clinical infection control but their use does not replace the need for effective hand decontamination.
6. The practice should ensure that spillages of body fluids or body waste, such as blood, faeces and urine, are cleaned up as quickly as possible.
Body fluid spills, such as blood, urine, faeces and vomit, can spread disease and produce unhygienic conditions if not cleaned up as soon as possible.
An agreed process for cleaning spillages should be in place.
Staff should be encouraged to treat a spillage as potentially infectious. For blood spillages an appropriate disinfectant should be used. For most spills, a 10,000ppm hypochlorite solution is typically used.
put on disposable gloves and apron (protective goggles should be used if there is danger of splashing) and ensure that the area of the spillage is well ventilated
if using a hypochlorite solution, prepare it in accordance with the manufacturer’s instructions — if using granules apply directly to the spill
cover the spillage with paper towels
carefully wipe up the spillage with more towels soaked in hypochlorite
dispose of the waste in a clinical waste bag
wash hands in soap and water.
Solid or semi-solid matter (eg faeces) in the spillage should be removed first as this can inhibit the disinfectant.
Chlorine-releasing disinfectants such as hypochlorite should not be used directly on urine spills as this can release irritant chlorine gas. Urine should be cleaned up using towels and the area cleaned with detergent before applying disinfectant.
7. Clinical equipment and apparatus must be cleaned and, where necessary, appropriately sterilised.
All clinical equipment that is not disposable and is not required to be sterile, eg basins, trays, trolleys and scissors, should be cleaned after use. Low-risk equipment can be cleaned sufficiently with hot water and detergent.
If sterile equipment is required, it is highly recommended for service providers to obtain single-use, disposable sterile equipment wherever practical. The use of such equipment should be covered by a policy that reflects current guidelines.
Where equipment does need to be sterilised and reused, it is recommended that decontamination services are provided by a local Central Sterile Services Department (CSSD). Where it is not practicable to use a CSSD provider, a practice may have to sterilise its own equipment, usually with a benchtop steriliser or autoclave.
For more information, see Cleaning and Sterilising Instruments and Equipment.
8. All practices should have a policy on the disposal of hazardous clinical waste. Such waste systems should be subject to regular risk assessment.
A general practice has a legal as well as moral duty to dispose of hazardous waste properly in accordance with a “duty of care” imposed under environmental legislation.
Waste is considered hazardous if it is potentially harmful to humans or the environment. Clinical waste includes items such as soiled surgical dressings, swabs and all other contaminated waste from treatment areas. Unless properly managed and handled, such waste can present a health hazard by spreading infection.
It is the responsibility of the practice to ensure that clinical waste is placed in suitably colour-coded bags and stored in a secure place while awaiting collection by a licenced waste carrier. Practice managers should check with their carrier to agree the exact arrangements.
Sharps waste, such as used syringe needles, will also represent an infection hazard unless safely disposed of. Such items should be sealed in appropriately designed sharps boxes, labelled with the name of the practice and then collected by an appropriate waste handler.
9. A source of infection control advice and support should be identified and outbreaks of infectious disease should be reported.
Each area will have a public health protection team which includes consultants and specialist nurses qualified to give immediate infection control advice. This will include advising when an outbreak needs investigation.
Service providers have the responsibility to report a suspected outbreak to their local team as soon as this is recognised and should act on any advice given.
10. Staff should be appropriately trained.
It is important that all members of staff working in the practice have a clear understanding of their responsibilities for hygiene and in preventing the spread of infection.
Staff should be trained in:
the basic principles of hygiene, especially the importance of effective handwashing, etc
general knowledge of infectious diseases, including modes of spread
the need to report personal illness and exclude themselves from work if suffering from an infectious disease
the need to wear disposable waterproof gloves in situations where contact with blood or body fluids is expected, such as when cleaning up body fluids.
Practice managers should ensure that infection control is covered in induction for new staff who should be made aware of the policies operating in the practice. Regular refresher training should also be provided.
You can find a Staff Training Presentation on Infection Control here, which you can distribute to your staff.