How can practice managers establish effective ways to avoid or limit the spread of infection in surgeries? Clinical governance expert Kirsten Dyer outlines her tips including on PPE, toys, general cleaning and more
While we have had guidelines for infection control for many years, the Covid-19 virus has really highlighted the value and the need for infection prevention and control.
It is easy in a busy GP practice to lose sight of the risk of infection and how vital prevention and control can be. All general practices and their staff require systems in place for effective risk prevention. A good start is to embed your approach to infection prevention and control into your regular standard practice activity.
This means that the practice teams have: clear and up to date practice policies and protocols in place; a person with clear accountability for oversight of infection prevention and control; monitor for risk; actively manage the environment; and take action when risk arises.
Evidence is clear that transmission can occur through various means, including contact, airborne and droplet methods. To establish effective infection prevention and control, your practice team should:
- have appropriate governance and systems in place
- be trained to understand the potential for and recognise risks
- be aware of mechanisms to prevent transmission
- know how to maintain the work and care environment/s and
- understand compliance and regulatory requirements in your region.
A summary of previous Medical Protection data from general practice demonstrated some areas requiring focus on infection prevention and control. These included:
- staff not being trained in effective hand hygiene
- lack of access to sharps disposal containers
- sharps disposal containers not close at hand
- spillage kits not being readily available
- routine cleaning of equipment, including toys.
In the UK, the Health and Social Care Act (2008) and the associated Code of Practice (in effect from 2022) on the prevention and control of infections and related guidance pays particular attention to infection prevention and control; cleanliness; antimicrobial stewardship; and specific criteria the Care Quality Commission (CQC) assess to review compliance of a registered provider.
Steps for practice managers to take action on
General practices must be able to demonstrate that they are meeting the CQC requirements. Some tips for your practice to consider include:
Have a lead person accountable for the oversight of infection prevention and control and have clear, up to date and easily accessible policies and protocols.
Organise planned, regular training (including as part of an induction) and skills development in preventing and managing infection. Support practice staff should be able to speak up and raise concerns about infection prevention and control/risks.
Regularly check that staff can access required equipment, including decontamination equipment in the event of exposure and that the practice systems accommodate active systems for monitoring and early identification of risk.
Open communication is helpful, with regular reporting back to staff and management about what is working well and where changes or improvements are required.
2. Awareness of current precautions/restrictions
With Covid-19 still presenting in the community, ensure practice staff are regularly updated on the status of Covid-19, and what restrictions and precautions are in place.
Review signage for use by practice staff, providing up to date and clear information and alerts to patients and others attending the practice (such as couriers) on hygiene measures and exclusions.
3. Practice environment
Cleanliness forms part of your prevention and control of infection and is included in the CQC code of practice. Practice guidelines should include a schedule for:
- daily, weekly and monthly cleaning tasks
- spillage management
- decontamination after events
- monitoring of incidents.
4. Hand Hygiene
Hand hygiene is easily achieved and is one of the most effective methods of preventing the spread of infection. It is important to remember that wearing gloves is not a substitute for effective hand hygiene.
Infections that cause vomiting, diarrhoea and respiratory infections are commonly linked to poor hand hygiene.
Despite hand washing being a common task, staff still need training and reminders in proper use of hand hygiene, including hand washing with soap and water and alcohol-based hand rubs.
It is helpful to also have hand hygiene information and reminders visible for patients and other visitors to the practice alongside hand hygiene equipment.
5. Personal Protective Equipment (PPE)
PPE is essential in some settings and some delivery of care. It is important that practice staff are able to assess potential risk of exposure and have access to PPE.
Additionally, practice staff need to be trained in the selection of appropriate PPE for the task, including, gloves, full face masks/visors, surgical face masks, aprons, and full body gowns/overalls.
PPE must be stored safely, easily accessible and properly disposed of after use in appropriate waste systems.
6. Clinical Waste
Have clear guidelines and a policy to ensure that practice staff:
- know who is responsible for monitoring waste management
- know how to dispose of confidential waste (i.e. patient details on materials)
- have access to training
- have access to appropriate waste containers
- have immediate access to sharps containers where sharps are in use
- are aware of segregation of waste (i.e. general, recycling, chemical/cytotoxic, clinical/biohazard)
- have access to PPE if required when managing waste
- are aware of storage requirements if waste is retained for period of time
- comply with the waste management duty of care, having all waste produce dealt with by a licensed waste management company.
Practices can audit their environment, checking that they have appropriate steps in place and that all staff know how to access and use spillage kits, and report and manage any sharps or body substance (blood, urine, vomit, faeces) exposure immediately.
Check and be sure that practice staff, particularly new staff, are aware of and up to date with vaccinations such as for Hepatitis B and Covid-19.
7. General cleaning
Given that infections can be spread by contact, droplet and airborne transmission, cleaning the entire practice environment is vital in prevention.
Think about the planned approach to regular cleaning for all areas, such as reception desks, benchtops, staff desks and associated equipment, kitchen areas, clinical and treatment rooms and equipment, chairs, examination tables, waiting room furniture, doors/door handles, floors, handwash basins, baby change tables, bathrooms and toys, for example.
There is evidence that shared toys can aide in the transmission of infection and any practice toys should be subject to cleaning after each use.
Toys should be easily cleaned, be of simple design and not have multiple moving parts. Check for breaks/cracks and discard damaged toys.
Consider having receptacles for used toys to be placed in, so they can be removed from circulation immediately after use and readied for cleaning.
Further information can be found in the national infection prevention and control manuals developed for each of the devolved nations:
- England – https://www.england.nhs.uk/wp-content/uploads/2022/04/National-infection-prevention-and-control-manual-v2-4-250123.pdf
- Wales – https://phw.nhs.wales/services-and-teams/harp/infection-prevention-and-control/nipcm/
- Scotland – https://www.nipcm.hps.scot.nhs.uk/
- Northern Ireland – https://www.niinfectioncontrolmanual.net/
Kirsten Dyer is senior clinical educator, Risk Prevention at the Medical Protection Society