Infection Control. Annual Report 2014 / 15

Transcription

1 Infection Control Annual Report 2014 / 15 July 2015

2 Report 1. Introduction and Background 1.1 The Trust supports the principle that healthcare acquired infections should be prevented wherever possible and, where this is not possible, that it is minimised to an irreducible level through effective systematic management. This Annual Report outlines the progress and arrangements in place to prevent and control Infection across Trust services for the period between April 2014 to March It highlights the achievements, compares data from previous years, and identifies areas that improvements can be made to strengthen compliance with the Health and Social Care Act 2012 for Delivering care in a safe and clean environment to reduce Healthcare Associated Infections (HCAIs) in the Trust is a priority and it is cognisant of its obligation to comply with the Code of Practice for health and adult social care on the prevention and control of infections and related guidance. 1.4 The infection prevention and control programme in place is overseen by the infection prevention and control committee which meets quarterly. It is continuously reviewed and builds on existing activities, driven by local needs, and incorporates the latest Department of Health (DH), Public Health England and other relevant strategies and regulations listed below to remain compliant. It is recognised that these strategies are more geared towards general hospitals however in the absence of dedicated mental health guidance, they provide a framework to develop local strategies: Acute trust toolkit for the early detection, management and control of carbapenemaseproducing Enterobacteriaceae, PHE, Dec 2013 Water Systems. Health Technical memorandum 04-01: Addendum Pseudomonas aeruginosa advice for augmented care units. March 2013 Legionnaires Disease. The control of legionella bacteria and guidance on regulations. Health and Safety Executive. Fourth edition 2013 Updated guidance on the diagnosis and reporting of Clostridium difficile. DH March 2012 Antimicrobial stewardship: Start smart then focus. Guidance for antimicrobial stewardship in hospitals (England). Advisory Committee on Antimicrobial Resistance and Healthcare Associated Infection (ARHAI), DH. Nov 2011 The Health and Social Care Act 2008 Code of Practice on the prevention and control of infections and related guidelines The National Institute for Health and Care Excellence (NICE) infection control guidance 2. Infection Prevention and Control Arrangements in place 2.1 The Chief Executive Officer (CEO) is the accountable officer for the quality of care delivered to the service users. This includes putting in place robust measures to prevent and reduce HCAIs for both patients and staff. 2.2 The Trust has a Director of Infection Prevention and Control (DIPC), and an Infection Control Team (ICT). The Executive Director of Nursing, Quality and Governance is the DIPC and reports directly to the CEO. 2.3 There is a Service Level Agreement for microbiology services and Infection Control Doctor (ICD) support with the Royal Free NHS Trust. The ICD is a core member of the Infection Prevention and Control Committee (IPCC). The ICD provides microbiology and infection control support to medical staff and the ICT.

3 2.4 There is 1 WTE Infection Control Lead Nurse, 1 WTE PLACE Lead/Senior Infection Control Nurse (1 WTE), and ½ WTE business administration support. All clinical areas have a nominated infection control link nurse. 2.5 The IPCC meets quarterly, and clinical services, Estates & Facilities, Occupational health, Pharmacy services and Public Health England are represented. 2.6 Pharmacy services have been working with the ICT and ICD to update the Trust antimicrobial policy. Work continues to develop effective antimicrobial stewardship. 2.7 The ICT produces bimonthly updates for the Clinical Quality and Safety Report and together with the IPCC minutes are presented to the Trust Board and the Clinical Quality Review Group with the commissioners. 2.8 The ICT produces an annual programme, which sets out the objectives for the year including the statutory infection prevention and control requirements for the Trust. The IPCC monitors delivery and implementation of the programme. 2.9 The annual programme follows the ten compliance criteria of the Code of Practice for health and adult social care on the prevention and control of infections and related guidance used by the Care Quality Commission to assess compliance The Trust Board approved the 2014/15 annual programme. All planned activities were delivered. 3. Care Quality Commission (CQC) Annual Health Check and Registration 3.1 The CQC carried out a number of inspections in the trust during 2014/15. They did not assess infection prevention and control compliance and did not raise any related concerns during any of their regulatory review/visits. 3.2 The Trust remains registered with the CQC without any conditions. 3.3 The Trust is at level one risk rating with NHS Litigation Authority risk management standards 4. NHS Trust Development Authority Visit 4.1 The NHS TDA infection control lead visited the trust in September 2014, and inspected Blue Nile ward, and Sussex ward on the Chase farm, and Magnolia at St Michael s. 4.2 The feedback was positive of the infection prevention and control measures in place in the trust. 4.3 The following recommendations were made: Complete the capital program to replace all non-compliant hand wash basins Secure medical leadership of antimicrobial stewardship Continue to engage with Public Health England and staff groups to improve Flu vaccination uptake 4.4 Work is in progress to address all the above recommendations. The Estates department is undertaking an audit of all clinical areas to identify the non-compliant hand wash basins. The programme to vaccinate front line healthcare workers against flu nationally ended in February 2015 and there was a 4.6% increase to 29.5% uptake compared to 2013/14.

4 5. Occupational Health 5.1 Occupational health is a contracted service in the Trust and is provided by People Asset Management Occupational Health Solutions. They provide screening for all new staff, staff immunisation including influenza vaccination, and blood borne virus exposure follow up. The occupational health nurse is a core member of the infection control committee. 5.2 The service provision meets the Trust Annual Infection Control Programme aims in terms of access to OH services for all employees, with pre-employment screening undertaken remotely via the Fit4Jobs process. This includes discussion and follow-up with any individual highlighting risk of, or known past infection of a communicable disease or infection, which is then managed according to the Department of Health guidelines (Green book). Any identification of requirement for immunisation relative to risk exposure in the work environment, is communicated to PAM Client Services with an appointment provided to further asses and vaccinate those considered at risk. Induction is attended by a representative of PAM to impart information relative to the service in general and specific information regarding Blood Borne Virus risk and incident management. 5.3 Management of occupational exposure to infectious disease is managed via a formal referral process, which currently is not an out of hour s service. Staff are advised to attend the local Accident and Emergency department initially following dynamic risk assessment in the work environment (with the appropriate supervisor and in line with Trust reporting procedures). This is followed up by OH, with relevant blood testing and immunisation boosters as appropriate, together with risk management advice. 5.4 There is also a PAM Helpline, which operates 24 hours a day, 7 days a week, which can be contacted following an exposure incident. 5.5 Management of general infectious disease has been undertaken on a case by case basis in liaison with the Infection Control Lead, and have included potential concerns raised in relation to employees diagnosed with latent tuberculosis, mumps and shingles. OH has provided relevant information and reviewed immunisation histories for groups of employees, to ensure the risks are managed effectively. 5.6 OH has worked closely with the Trust s Flu Action Group to optimise the uptake of the Flu vaccine by staff. See main report for outcomes. 6. Decontamination 6.1 The majority of medical devices within the Trust that require decontamination are within ECS (Enfield Community Services). The service has robust processes in place to ensure effective segregation of clean and used medical devices. Used devices are decontaminated in a designated area by an appropriately trained person. Where appropriate all reusable devices have been changed over to single use or single patient devices to minimise the risk of infections. 6.2 Podiatry and Sexual Health services continue to use single use instruments in order to minimise the risk associated with decontaminating reusable medical devices. 6.3 There is a rolling training programme on the management of medical devices in the Trust and these are provided by the current medical devices contractor EBME Ltd. Compliance is overseen by the Estates department. 7. Safe Management of Healthcare Waste: HTM: The Trust uses approved waste contractors to dispose of general and clinical waste. The Trust remains compliant with the Safe management of Healthcare Waste: HTM

5 7.2 The colour coding requirements for cleaning equipment and bins are in place in all areas. 7.3 Community staff transporting clinical waste and sharps back to their bases or to clinics for safe disposal have been supplied with transport containers. 7.4 There is a collection and storage compound for cytotoxic and cytostatic waste at the St Michael s site. Pharmacy at St Ann s occasionally produces a small amount of cytotoxic or cytostatic waste and whenever they are produced they are disposed through the proper channels by facilities. 8. Outbreaks 8.1 The Trust has an established framework for the management of outbreaks. This has enabled the Trust to minimise the impact on patients. 8.2 Baytree House - Investigation of three patients colonised with Meticillin Resistant Staphylococcus Aureus (MRSA) over a period of 2 months (August-September 2014) This was investigated as all three patients presented with similar symptoms despite being over a long period of time. Swabs taken showed all three patients were colonised with the same strain. Public Health England and the CCGs were informed. Strict infection control measures were implemented on the ward and all patients were screened to try to find the source. Isolation was not practical in this patient group. None of the other patients tested positive which led to the conclusion that the last case was possibly the source. After decolonisation there was no further transmission. The ward continues screening all high risks patients and there has been no further cases reported. 8.3 Silver Birches - Increased period of vomiting (October 2014) Over a 5 day period, 5 patients developed vomiting. Each patient experienced one episode. It was an unusual presentation especially when there were no cases between day 2 and 4. The ward was reviewed daily with the infection control doctor but not closed to admissions. Strict infection control measures were in place. Microbiological samples taken were sent to the laboratory and were all clear. 9. Healthcare Associated Infections (HCAIs) and Mandatory reporting 9.1 The trust has a good working relationship with the local laboratories and all notifiable organisms under the notifiable diseases act 2010 including reportable healthcare associated infections are reported promptly over the telephone by the infection control team or the microbiologist. 9.2 The healthcare associated infection are MRSA bacteraemias, MSSA bacteraemias, Glycopeptide-Resistant Enterococci (GRE), E. Coli bacteraemias and Clostridium difficile associated diarrhoea (CDAD), and the Carbapenemase-producing Enterobacteriaceae 9.3 Cases are apportioned to an organisation based on when and where it was isolated. The ICT review and report on all cases apportioned to the Trust. Learning are shared with the team and presented at the quarterly infection control link nurses meetings. 9.4 Meticillin Resistant Staphylococcus Aureus (MRSA) bacteraemia: there were none during 2014/ Screening for Meticillin Resistant Staphylococcus Aureus (MRSA) The 2014 guidelines Implementation of modified admission MRSA screening guidance for NHS (2014) recommended that Trusts move to a focussed screening programme. In the trust, patients identified as high risks are screened on admission. High-risk

6 patients are those coming from a general hospital where there is a known outbreak, post-surgical procedures, care home settings, and those with chronic wounds and invasive lines. Enfield Community Services inpatient ward (Magnolia unit) provides physical care rehabilitation and the unit continues screening all new admissions. This is carried out within 24 hours of admission and has been standard practice since It provides an indicator of infection control standards on the unit. The graph below shows the number of admissions on the unit by month and the number of patients colonised with MRSA picked up on the admission screen. It shows the number of patients testing positive during their stay. The incidence of patients acquiring MRSA on the unit remains rare. Figure 1: MRSA admission screens on Magnolia unit from April March Apr-14 May-14 Jun-14 Jul-14 Aug-14 Sep-14 Oct-14 Nov-14 Dec-14 Jan-15 Feb-15 Mar-15 Number of admissions to Magnolia Unit Number of positive inpatients Number of patients positive on admission 9.6 Clostridium difficile (C.diff) Department of Health 2012 guidance on Clostridium difficile testing advocates that Trusts move from the standard EIA toxin tests to a two stage test with antigen detection (GDH) and EIA, due to the poor sensitivity and specificity of the EIAs. The local laboratories have implemented those recommendations and as a result are detecting more cases There were five separate Clostridium difficile cases in 2014/15 compared to none in 2013/2014. Four of the five cases were GDH positive, which previously would not have been detected. Two patients were admitted with C. diff from another healthcare provider, and one from the community. All five patients were fully investigated to assess the likelihood of true disease, and any avoidable risk factors or lapses in control measures. No lapses were found on investigation C. diff root cause analysis: there have been two separate RCAs undertaken, one in December 2014 and in March 2015, on-going investigations with the CCG regarding two Enfield residents who passed away with C. diff which was detected within 24 hours of hospital admission to a local district general hospital. Because the C. diff were detected within 24 hours of admission they were both classed as community acquired. The CCG is

7 leading on both investigations and is working with the Trust, and the local acute hospital infection control lead to identify causation and learning. 10. PLACE Assessment 10.1 The 2014 assessment was completed in June 2014 and was submitted to the Health and Social Care Information Centre. The 2014 PLACE assessment report was presented to the Trust board in November The graph below shows the Trust scored above the national average in all areas inspected. 100% 98% 96% 94% 92% Figure 2: The Trust confirmed PLACE results for 2014 against national average 99.64% 97.25% 94.52% 93.85% 92.15% 91.97% 90% 88% 86% 88.79% 87.73% BEH National Average 84% 82% 80% Cleanliness Food Privacy, Dignity and Wellbeing Condition Appearance and Maintenance 11. Audits 11.1 There is an established audit programme including hand hygiene, infection control practice, and cleaning standards carried out monthly in addition to inspection requests from ward staff, and managers. Spot checks and full Hygiene Code inspections are carried out to provide the Trust with further assurance on compliance Results are collated quarterly and displayed in public areas on all the wards. Findings are discussed at the IPCC, infection control link nurses meetings, Deep Dive meetings, and included in the Clinical Quality and Safety report for the board. The three graphs below shows compliance from April 2014 to March Hand Hygiene Audits The Trust promotes the WHO (World Health Organisation) 5 moments to Hand Hygiene at the point of care. There is regular hand washing training in all clinical areas The Hygiene Code requires the Trust to audits hand hygiene practice regularly and the Trust complies with this by auditing a sample of staff every month on all the wards The graph below, figure 3, shows compliance with the hand hygiene policy from April 2014 to Mar 2015, monitored by the ICT and the ward based infection control link nurses. From April 2014 overall compliance remained good and consistent throughout the Trust.

8 Apr-14 May-14 Jun-14 Jul-14 Aug-14 Sep-14 Oct-14 Nov-14 Dec-14 Jan-15 Feb-15 Mar-15 Apr-14 May-14 Jun-14 Jul-14 Aug-14 Sep-14 Oct-14 Nov-14 Dec-14 Jan-15 Feb-15 Mar % Figure 3: Average monthly hygiene scores April 2014-March % 90% 85% 80% 75% 70% 65% 60% 11.4 Infection Control Audits These monthly audits measures compliance with the Hygiene Code. It looks at a number of areas ranging from the care environment to infection prevention and control practice The graph on the next page shows the average monthly infection control audits and compliance remains good overall. The variations were environmental issues around cleanliness and the fabric of the building which can be recurrent in some areas. 100% Figure 4: Average monthly infection control audit scores April 2014-March % 90% 85% 80% 75% 70% 65% 60% Series1

9 11.5 Standard of Cleaning Audit The cleaning service is contracted out to Medirest and their supervisors audit all areas they clean monthly. The Facilities manager employed by the trust carries out further checks. The ICT and link nurses audit all inpatient areas part of the infection control audits. To ensure consistency the audit tool is based on the 49 elements of the National specifications for cleanliness in the NHS (2007) The graph below shows the average cleaning scores since from 2014 to March Figure 5: Average monthly cleaning audit scores April 2014-March % 95% 90% 85% 80% 75% 70% Apr 14 - Jun 14 Jul 14 - Sept 14 Oct 14 - Dec 14 Jan 15 - Mar 15 Average 1/4 Cleanliness Scores 12. Infection Control Training 12.1 Infection prevention and control training is part of the trust mandatory induction for new staff and the three-yearly update for existing staff. Attendance over the last three year is 88% 12.2 Infection prevention and control training takes place at the quarterly infection link nurses meetings, on the wards and at team meetings. These are based on preceding events for example, post outbreak, or an increase of infection in a particular area. 13. Flu Vaccination 13.1 Improving uptake in front line staff was a priority for the Trust s 2014/15 campaign. Insufficient drop-in clinics were previously raised as in issues; therefore the number of clinics was doubled compared to last year across all Trust s sites Occupational health visited all the wards to vaccinate those finding it difficult to attend the drop-in clinics There was a strong communication campaign in the trust, and dates and venues were advertised on computer screen savers, Take 2, and s were sent out to all staff Uptake improved by 4.6% to 29.5%. 2013/14 uptake was 24.9%. 14. See Appendix 1 for the Infection Control Work plan for 2015/2016

10 15. Budgetary / Financial Implications Implications 15.1 For the trust to remain compliant with the Hygiene Code additional resources, consumables, and capital work may be needed which will have budgetary implications. 16. Risk Management 16.1 The trust has systems and processes in place to prevent and control infections. Any new risk will be assessed, addressed, and escalated to the appropriate level 17. Equality and Diversity Implications 17.1 Infection prevention and control activity improves the quality of the services delivered hence promotes equality and diversity.

11 Appendix 1 Reducing Healthcare Associated Infection (HCAI): BEH - MHT Annual Work plan 2015/2016 This document provides the trust with an annual programme to reduce the risks of Healthcare Associated Infections (HCAIs) to all its service users and staff for the period of April 2015 to March The programme draws from past and present key initiatives from legislation, directives, and expert guidance. The DIPC will oversee the delivery of this programme through the Infection Control Committees and the work of the infection control team. The trust places a duty of care on all its employees to ensure the delivery of safe clean care to all its service users and to follow best evidence based practice at all times. Key documents: The Health and Social Care Act 2008 Code of Practice for prevention and control of Infections and related guidance. Advice on the prevention and control of healthcare-associated infections: scope (NICE) 2012 CQC Standards of Quality and Safety: Cleanliness and infection control National Decontamination Strategy (NHS Estates) 2004 Mandatory surveillance of MRSA bacteraemias (DOH) 2005 Mandatory surveillance of C. difficile infection (DOH) 2005 Clostridium difficile infection objectives for NHS organisations 2014 EPIC 3: National evidence-based guidelines for preventing healthcare associated infection in NHS hospital England: 2013 Acute trust toolkit for the early detection, management and control of carbapenemase-producing Enterobacteriaceae, PHE, Dec 2013 Water Systems. Health Technical memorandum 04-01: Addendum Pseudomonas aeruginosa advice for augmented care units. March 2013 Legionnaires Disease. The control of legionella bacteria and guidance on regulations. Health and Safety Executive. Fourth edition 2013 Updated guidance on the diagnosis and reporting of Clostridium difficile. DH March 2012 Antimicrobial stewardship: Start smart then focus. Guidance for antimicrobial stewardship in hospitals (England). Advisory Committee on Antimicrobial Resistance and Healthcare Associated Infection (ARHAI), DH. Nov 2011 The National Institute for Health and Care Excellence (NICE) infection control guidance This programme may be altered if significant new risks are identified or resources do not allow the activity to be carried out.

12 Criterion 1 Area Systems to manage and monitor the prevention and control of infection. These systems use risk assessments and consider how susceptible service users are and any risks that their environment and other users may pose to them Requirement Action Accountability Timescale Achieved Board Assurance Framework Designation of DIPC Bimonthly update to the Clinical Quality and Safety Committee, and an Annual report to Trust Board Infection control programme in place Programme of audit of key policies and practices Policy for information sharing when admitting, transferring, discharging and moving service users within and between health and social care. Provide infection control training and update to all staff All services are risk assessed and monitored Decontamination lead Board Level agreement DIPC Update infection control audit programme to include all clinical services Infection control training needs to be reported to IPCC and trust board Audit compliance with the following trust policies: Hand Hygiene (Monthly) Standards of Cleanliness (Monthly) Infection control audit (Monthly) Update the antimicrobial policy Audit compliance with antibiotic policy ICT ICT Service managers/ All clinical services/ Facilities DIPC, ICD, ICT and Pharmacist Pharmacy Work in progress Deliver Infection control training to all staff ICT On going To have a designated decontamination lead DIPC

13 Criterion 2 Area Provide and maintain a clean and appropriate environment in managed premises that facilitates the prevention and control of infections Requirement Action Accountability Timescale Achieved Designated leads for cleaning and decontamination of equipment used in diagnosis and treatment Develop policies to include local cleaning schedules of medical devices in each area Ward manager/ decontamination lead/ebme/ict Decontamination policy Liaise with service managers and facilities management for contract negotiation, specifications, and service planning delivery Service managers have accountability for delivering a safe clean care environment Care environment is kept clean, maintained and fit for purpose Cleaning policy, schedule, arrangements and details for all care environment Waste management policy Adequate hand hygiene facilities Linen and Laundry arrangements in place in line with HSG 95 Management of water supplies and the risk of Legionella is minimised Decontamination lead to develop annual programme of audit and training Decontamination Manager to provide bi annual report to the trust board Decontamination of medical devices takes place in appropriate facilities Monthly environmental audits Compliance with Bare below the elbow policy to be included into the hand hygiene audit Review cleaning policy and schedule and ensure all relevant personnel have access to it Decontamination Manager Decontamination Manager Decontamination Manager/EBME Ward manager/ict/facilities ICN Facilities/ICT Review waste management policy Facilities/ICT Review linen and laundry arrangement to reflect current requirements Ensure there are regular updates on water supplies testing and maintenance at every ICC Facilities Estates 6-monthly

14 Criterion Area 3 Provide suitable accurate information on infections to service users and their visitors. Requirement Action Accountability Timescale Achieved General principles on the prevention and control of infection and key aspects of the registered provider s policy on infection prevention and control, which takes into account the communication needs of the service user Review intranet pages for staff and public Review patient information leaflets: MRSA C.Diff Review infection control information for ICT ICT ICT/ward As required The roles and responsibilities of particular individuals such as carers, relatives and advocates in the prevention and control of infection, to support them when visiting service users Supporting awareness and empowerment in the safe provision of care by service users The importance of compliance by visitors with hand hygiene The importance of compliance with the registered provider s policy on visiting Reporting failures of hygiene and cleanliness Explanations of incident/outbreak management Information should be developed with local service user representative organisations, which, in the NHS, would include Local Involvement Networks (LINks) and Patient Advice and Liaison Services (PALS) visitors in inpatient areas managers Update management of outbreak policy ICT/ICD As required Regular updates on hygiene and cleaning standards Facilities/Unit manager/service managers Monthly Ensure staff and visitors are aware how to report failures in cleanliness and hygiene On going

15 Criterion 4 Area Provide suitable accurate information on infections to any person concerned with providing further support or nursing/medical care in a timely fashion Requirement Action Accountability Timescale Achieved Accurate information is communicated in an Update admission/discharge/transfer ICT appropriate manner Information accompanies the service user Provide relevant information across organisational boundaries policy Audit compliance with completion of admission/transfer/discharge letter Ward managers Criterion 5 Area Ensure that people who have or develop an infection are indentified promptly and receive the appropriate treatment and care to reduce the risk of passing on the infection to other people Requirement Action Accountability Timescale Achieved Ensure that advice is received from suitably Ensure regular communication between All On going informed practitioners and that, if advised, inform the PHE of any outbreaks or serious infection occurrences Arrangement to prevent and control infection should demonstrate that responsibility for infection prevention and control is effectively devolved to all groups in the organisation involved in delivering care clinical staff and ICT Ensure all staff including bank/agency staff receive infection prevention and control training ICN & Learning and development team Ensure staff are clear about their roles and responsibilities HR, line managers

16 Criterion 6 Area Ensure that all staff and those employed to provide care in all settings are fully involved in the process of preventing and controlling infection Requirement Action Accountability Timescale Achieved Ensure staff, contractors and other involved in the provision of care co-operate with each other to prevent and control infection Ensure that the admission/transfer/discharge summaries are completed by all relevant services All clinical staff Regular audit of admission/transfer/discharge summaries Ward managers Criterion Area 7 Provide or secure adequate isolation facilities Requirement Action Accountability Timescale Achieved Provide, or secure the provision of, Ensure there are sufficient isolation Ward On-going adequate isolation precautions and facilities as appropriate, sufficient to prevent or minimise the spread of infection facilities Update isolation and segregation policy of infectious patient managers/estates/ict/dipc ICT As required Policies should be in place for the allocation of patients to isolation facilities based on a local risk assessment. The assessment could include consideration of the need for special ventilated isolation facilities. Sufficient staff should be available to care for the service users effectively Provide facilities to physically separate the service user from other residents in an appropriate manner in order to minimise the spread of infection

17 Criterion Area 8 Secure adequate access to laboratory support as appropriate Requirement Action Accountability Timescale Achieved Ensure that laboratories used to provide microbiology service in connection with arrangements for infection prevention and control have in pace appropriate protocols and that they operate according to the standards required for accreditation by Clinical Pathology Accreditation (UK) Ltd Check for accreditation SLA ICN Yearly Criterion 9 Area Have and adhere to policies, designed for the individual s care and provider organisations, that will help to prevent and control infections Requirement Action Accountability Timescale Achieved Have appropriate policies as mentioned below and should be clearly marked with a review date. Update the infection control policy ICT As required a. Standard infection prevention and control precautions b. Aseptic technique c. Outbreaks of communicable infection d. Isolation of service users with an infection e. Safe handling and disposal of sharps f. Prevention of occupational exposure to bloodborne viruses (BBV s) including prevention of sharps injuries g. Management of occupational exposure to BBVs and post-exposure prophylaxis h. Closure of rooms, wards, departments and premises to new admissions i. Disinfection

18 j. Decontamination of reusable medical devices k. Single-use medical devices l. Antimicrobial prescribing m. Mandatory reporting of healthcare associated infections to the Health Protections Agency n. Control of outbreaks and infections associated with specific alert organisms MRSA Clostridium difficile Glycopeptide resistant enterocci Acinetobacter and other anti-biotic resistant bacteria Viral haemorrhagic fevers Creutzfeldt-Jakob disease, variant CJD and other human prion diseases Relevant policies for other specific alert organisms o. CJD/vCJD handling of instruments and devices p. Safe handling and disposal of waste q. Packaging, handling and delivery of laboratory specimens r. Care of deceased persons s. Use and care of invasive devices t. Purchase, cleaning, decontamination, maintenance and disposal of equipment u. Surveillance and data collection v. Dissemination of information w. Isolation facilities x. Uniform and dress code y. Immunisation of service users

19 Criterion 10 Area Ensure, so far as is reasonably practicable, that care workers are free of and are protected from exposure to infections that can be caught at work and that all staff are suitably educated in the prevention and control of infection associated with the provision of health and social care Requirement Action Accountability Timescale Achieved All staff can access occupational health services or access appropriate occupational health advice Work with HR to ensure the Occupational health SLA covers all these requirements Workforce Team/ICT/DIPC On-going Occupational health policies on the prevention and management of communicable infections in care workers are in place There is a record of relevant immunisations The principles and practice of prevention and control of infection are included in the induction training programmes for new staff. The principles include: ensuring that policies are up to date; feedback from audit results; feedback from audit results; examples of good practice; and action needed to correct poor practice On-going education for existing (including support staff, agency/locum staff and staff employed by contractors), which should incorporate the principles and practice of prevention and control of infection. Training records are up to date Prevention and control of infection responsibilities of staff are reflected in their job description and in any personal development plan or appraisal. OH services should include a risk-based preemployment screening for communicable diseases and assessment of immunity to infection and on-going health surveillance. Include Infection prevention and control responsibilities in staff job description, and appraisal Workforce/ICT/DIPC

20 Provision of relevant immunisations. Having arrangement in place for regularly reviewing the immunisations status of care workers and providing vaccinations to staff as necessary in line with Immunisation against infectious diseases ( The Green Book ) and other Department of Health guidance. OH services in respect of BBV should include having arrangements for identifying and managing healthcare staff infected with hepatitis B or C or HIV and advising about fitness for work in line with Department of Health guidance Liaising with the UK advisory Panel for Healthcare Workers Infected with Bloodborne Viruses when advice is needed on procedures that may be carried out by BBVinfected care workers, and when patient tracing, notifications and offer of BBV testing may be needed Management of occupational exposure to infection, which may include provision for emergency and out-of-hours treatment, possibly in conjunction with accident and emergency services and on-call infection prevention and control specialists.