Footfriend - Infection Control Policy

Patient safety is a cornerstone of care and preventing healthcare-associated infections is a priority. All patients have a right to expect certain standards when accessing healthcare, and not to be exposed to unnecessary risks. Healthcare associated infections are caused by a wide range of microorganisms. They can be transmitted from one person to another but are often carried by patients themselves and have taken advantage of a route into the body provided by an invasive procedure. As well as causing unnecessary illness, and potentially in the severest circumstances death, infections delay recovery and adversely affect quality of life. Healthcare workers, family members and carers are also at risk of acquiring infections when caring for patients. Healthcare workers specifically are at an increased risk of infection from blood borne viruses. As practitioners we understand the risk of cross infection. These risks must be mitigated through the implementation of effective infection prevention and control measures, such as those described in this document. These are an essential part of high-quality care and contribute to the safety of patients, healthcare staff and others. This policy is written in an easy to understand and follow format (hopefully jargon free) showing that we follow all the cornerstones of best practise in infection control in a clinical setting such as a podiatry clinic. It covers all areas recommended by our professional body “The College of Podiatry”.

Standard Infection Control Precautions

Standard infection control precautions should be followed at all times. Standard infection control precautions must be put in place to reduce the risk of transmission of micro-organisms during healthcare activities. They are necessary to ensure the safety of patients, health care workers and visitors to healthcare environments. Standard infection control precautions cannot prevent infection transmission from all infectious agents, and where specific infectious agents are suspected or known additional transmission-based precautions may be required (e.g. droplet precautions for preventing the spread of influenza). Standard infection control precautions include:

• Hand decontamination>
• Use of Personal Protective Equipment (PPE)
• Occupational Exposure Management including sharps
• Safe disposal of clinical waste
• Correct dealing with spillages of blood and body fluids
Management of the Clinical Environment
• Management of Equipment.

 

Hand Decontamination

Infections, endemic in the community, are also commonly spread through direct or indirect contact, mediated by hands. So good hand hygiene, by everybody is an important way of preventing spread. To prevent the spread of healthcare associated infection, it is vital for those providing care to decontaminate their hands at all the right times, and in the correct way.

When Everyone should decontaminate their hands:

• Before starting work and before going home
• After using the toilet
• Before eating and handling preparing food
• After handling pets
• After handling raw food
• After any cleaning activities
• After potential contact with body fluids
• After handling refuse and clinical waste
• When hands look or feel dirty

Hands should be washed at designated hand wash basins which must not be used for other activities.

Hand Washing (with soap and water or antiseptic solution and water)

An effective handwashing technique involves three stages: preparation, washing and rinsing, and drying. Preparation requires wetting hands under tepid running water before applying liquid soap or an antimicrobial preparation. The hand wash solution must come into contact with all of the surfaces of the hand. The hands must be rubbed 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. Hands should be rinsed thoroughly before drying with good quality paper towels.

Hand Decontamination (with alcohol hand rub)

When decontaminating hands using an alcohol hand rub, hands should be free from dirt and organic material. The hand rub solution must come into contact with all surfaces of the hand. The hands must be rubbed together vigorously, paying particular attention to the tips of the fingers, the thumbs and the areas between the fingers, until the solution has evaporated and the hands are dry.

Personal Protective Equipment (PPE)

In healthcare, exposure to micro-organisms and chemicals cannot be completely removed so PPE is used to manage the risk. PPE includes:

• Gloves
• Aprons
• Face, mouth/eye protection, e.g. masks/protective eyewear.

 

PPE must be used where there is a risk that a healthcare worker may come into direct contact with blood or other body fluids, non-intact skin, mucous membranes or contaminated equipment.

Which PPE is required should always be decided following an assessment of the risk of contamination of the healthcare workers’ clothing and skin by the patients’ blood, body fluids, secretions or excretions and the risk of transmission of infection to the patient (see below).

Use of PPE according to Risk

Low Risk

No risk of contact with blood and body fluids – PPE not required

Moderate Risk

Risk that clothing or skin will be contaminated with blood and body fluid – apron and gloves

High Risk

Risk that eyes, clothing or skin will get splashed with blood and body fluids – Eye and face protection, water repellent gowns and gloves

Most PPE is single use and should not be re-used.

The use of PPE such as gloves does not negate the need for hand hygiene. Hand hygiene should be performed before donning and after disposal of PPE.

Respiratory protective equipment, for example a particulate filter mask (FFP), must be used when clinically indicated.

Practitioners should use devices such as pocket masks to protect against exposure during mouth-to-mouth resuscitation

Occupational Exposure management including sharps injuries

Exposure to potentially infectious body fluid/blood may be caused by:

• A cut or puncture of the skin by a contaminated sharp (blade, needle)
• Through exposure of broken skin to body fluid/blood
• Bites which break the skin and draw blood.

 

Such exposure may result in the transmission of blood borne viruses such as HIV, Hepatitis B (HBV) and Hepatitis C (HCV). Infection with these pathogens may be serious. Even where no infection is acquired, the emotional impact of such an injury may be severe. Transmission of Blood borne virus requires inoculation of an infectious dose of infected body fluid into a susceptible recipient. The infecting dose may be as low as a visible drop of blood. However, individual factors affect the risk of transmission.

In relation to blood-borne infections urine, faeces, vomit, sweat, tears, skin and sputum are not considered high risk unless visibly blood-stained.

The risk of transmitting blood borne viruses from patients to staff is greater than from staff to patients. Unfortunately, inoculation (sharps) and exposure injuries to healthcare staff are common.

There is no evidence that BBVs can be transmitted by blood contamination of intact skin, by inhalation or by faecal-oral contamination. A simple injury, which does not break the skin or does not involve the inoculation of body fluids, is unlikely to lead to the transmission of infection.

There is a smaller risk of transmission from splashes to eyes, nose or mouth with infected blood or body fluid.

BBVs are potentially transmissible by a human bite through mucous membrane exposure if the bite breaks the skin of the person bitten.

Thankfully most sharps injuries and other exposures to blood and body fluids are preventable.

Percutaneous (often called Sharps) Injuries

Percutaneous exposure results from inoculation with a sharp instrument such as a scalpel blade or needle, used in clinical care, which may have been contaminated with blood, or a “high-risk” body fluid. However, lancets, razors, scissors, test tubes and even fragments of bones or patients’ teeth can also cause sharps injuries.

Injuries may affect cleaners and other staff handling waste after disposal if sharps are not disposed of properly.

Sharps injuries must be immediately dealt with.

Use and Disposal of Sharps

Sharps:

• Assess all tasks involving the use of sharps, putting in place any additional measures required to prevent injury
• Minimise unnecessary use of sharps 
• Use gloves when using sharps
• Needles must not be bent or broken before disposal and must not be recapped.
• Never try and retrieve items from a sharps bin
• Should be handled as little as possible.
• Must not be passed directly from hand to hand
• Must be discarded immediately by the person generating the sharps waste into a sharps container conforming to current standards

Safe Disposal of Clinical Waste

Healthcare waste must be:

• Segregated immediately by the person generating the waste into appropriate colour-coded storage or waste disposal bags or containers which are compliant with current national legislation
• Labelled, stored, transported and disposed of in accordance with current national legislation

Management of The Clinical Environment

Micro-organisms persist in the environment and the design and the condition of the healthcare environment and of fixtures and fittings is important in infection control.

Clinical areas should be kept tidy and clutter free to allow effective cleaning and prevent accumulation of dust.

Work surfaces and hard floors should be smooth-finished, intact, durable, of good quality, washable, should not allow the pooling of liquids and be impervious to fluids.

Curtains in treatment areas should be disposable or cleaned when soiled or periodically.

Cleanliness is intrinsically linked to infection prevention and control. A clean, well ordered environment provides the foundation for excellent infection control practice to flourish. All parts of the healthcare environment must be visibly clean but good cleaning ensures that things not only look clean but that they are clean

Management of Equipment

Equipment used for the care of patients is a potential source of infection and must be decontaminated appropriately between uses (unless single use in which case it must not be re-used) and stored so as to prevent contamination.

It must be:

• stored clean and dry (not on the floor, and not in an area with dirty equipment or where decontamination takes place)
• checked for cleanliness prior to use, e.g. when being removed from storage
• decontaminated appropriately
• The level of decontamination required will depend on the use of the equipment and the level of contamination.

 

There are three levels of decontamination:

1. Cleaning
2. Disinfection
3. Sterilisation Equipment that may have been contaminated with blood or body fluids (other than urine) should be disinfected with a chlorine releasing agent.

 

It is important to note that neither disinfection nor sterilisation can take place without prior cleaning. Consequently, where disinfection is required items must first be cleaned, using detergent and dried.

Alcohol is a disinfectant and will only work effectively on clean items.

Wipes can be useful for cleaning and decontamination of small areas of the environment and for equipment, but it is important to make sure that the wipe being used will decontaminate to the level required and that a proper method is used to prevent recontamination. Where detergent wipes are used, items/areas must also be dried.

Orthotics

Used orthotics must be decontaminated before being sent to the laboratory, they should not be sent if they pose a risk of transmission of infection. Discuss any concerns with the laboratory before sending.

Contaminated soft furnishings and carpets that cannot withstand chlorine releasing agents should be cleaned with a solution of detergent and warm/tepid water followed by steam cleaning.

If it is not possible to use either of these methods, it may be necessary to dispose of contaminated soft furnishings.

Other Measures

Transmission based precautions

Patients who have specific infections, with a known route of transmission, may need to be managed with additional precautions (Standard Infection Control Precautions always apply).

Judicious use of Antimicrobials

Infections which are resistant to antimicrobials are likely to be one of the biggest challenges to healthcare in the future. Infection control and judicious use of antibiotics work together to help meet this challenge.

Antimicrobial choice should be based on microbiology and the narrowest effective spectrum should be used. Local guidelines should be followed where available.

Skin preparation

Skin preparation aims to reduce microbial burden before treatment.

The best way of reducing this burden is to ensure that patient’s feet are cleaned with soap and water before treatment.

Podiatrists should undertake an assessment before deciding on the skin preparation they choose. This should take account of:

• Patient hygiene (many preparations have reduced activity in the presence of dirt and organic matter)
• Sensitivities, allergies and acceptability to patients
• Residue which might affect treatment e.g. moisturisers in skin wipes may leave a film that affects the use of a blade on skin)
• Type of procedure being undertaken (A 2% chlorhexidine in alcohol preparation would be recommended before an invasive procedure)

 

Clothing

Clothing that can be washed at least 60 degrees and ironed should be worn for direct patient care. Clean workwear should be worn every day. It should be changed if it becomes heavily soiled or contaminated. Work wear should be changed as soon as possible after patient care activities. Shoes should be closed in and protect the feet from possible sharps injury.

Aseptic technique

An aseptic technique ensures that only uncontaminated equipment and fluids come into contact with susceptible body sites. Asepsis reduces the risk of an infection developing as a result of a procedure being undertaken. It should be used during any clinical procedure that bypasses the body’s natural defences; this includes all invasive procedures including wound care. An aseptic technique involves specific actions and procedures performed under controlled conditions. The ability to control conditions will depend on the setting where the procedure takes place, but the principles remain the same:

• the area where the procedure takes place should be as clean as possible
• minimise air disturbance in this area during the procedure e.g. avoid sweeping, using a fan, having building work going on
• perform hand hygiene prior to and during the procedure as required (see 5 Moments)
• use sterile equipment
• use a non-touch technique (utilise sterile gloves/forceps if required) to ensure that sterile parts are not contaminated

 

Communication

While bearing in mind patient confidentiality, others involved in a patient’s care should be informed of risks from infection.