Infection Prevention and Control. Standard Precautions Policy

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1 Infection Prevention and Control Standard Precautions Policy

2 Policy Title: Executive Summary: Implementing standard universal precautions underpins safe practice in protecting, staff, patients and visitors for healthcare associated infections. Cross infection may occur when there is contact with blood, tissue and or bodily fluid, material and equipment. Supersedes: Standard Precautions Policy 2015 Description of Amendment(s): Updated to reflect National guidelines This policy will impact on: All staff employed by the Trust, including contractors Financial Implications: None currently identified outside of current Directorate ordering Policy Area: Infection Prevention and Control Trust Wide Document Reference: ECT Version Number: Issued By: V2 Effective Date: October 2017 Infection Prevention and Control Group Review Date: October 2020 Author: Wendy Morris Clinical Specialist Practitioner Infection Prevention and Control Impact Assessment Date: October 2017 APPROVAL RECORD Consultation: Committees / Group Infection Prevention and Control Group Date November 2017 Approved by Director: Director of Nursing Quality and Performance DIPC November 2017 Ratified by: Infection Control Committee November 2017 Received for information: Service Line SQS Groups December 2017 Standard Precautions Policy November 2017 Page 2

3 Table of contents 1. Introduction Page 4 2. Purpose Page 4 3. Organisational responsibilities Page 4 4. Processes and procedures Page 5 5. Monitoring compliance with the document Page References Page 17 Appendix 1 Sharps injuries flowcharts Page 18 Standard Precautions Policy November 2017 Page 3

4 1. Introduction Standard Precautions underpin safe practice thereby protecting patients, staff, and visitors from acquiring healthcare associated infections (HCAIs) from recognised and unrecognised sources. Cross infection may occur following contact with blood, tissue and / or bodily fluid, materials and / or equipment. The Health and Social Care Act (DOH updated 2015), Care Quality Commission standards and the Health and Safety at Work Act (1974) make explicit the statutory and legal duty placed on NHS organisations to manage, mitigate and control the risk of transmission of HCAIs. The appropriate level of precautions to be taken for any procedure should be determined according to the extent of possible exposure to blood and body fluids, in association with evidence based and national guidance. This should be based on risk assessment and not due to speculation about the infectious status of the patient. Implementing these standards will ensure the risk of transmission is minimised. 2. Purpose The purpose of this policy is to detail the anticipated infection prevention and control (IPC) standard precautions that all healthcare staff across the East Cheshire health economy must abide to. Adherence to this policy will reduce the risks of transmission of infection, and environmental contamination by micro-organisms and therefore protect patients, carers, visitors and staff from infection. Standard Precautions incorporate: Staff immunisation and illness Hand decontamination (as per the hand hygiene policy) Effective use of Personal Protective Equipment (PPE) Safe management of sharps Cleaning and decontamination of equipment (as per trust cleaning policy) Environmental cleaning (as per trust cleaning policy) Waste management ( as per trust waste policy) Safe handling of used linen (as per trust waste policy). Isolation (as per trust isolation policy) This policy must be read in conjunction with the following policies: Hand hygiene policy Decontamination of medical and laboratory equipment prior to maintenance or transportation Decontamination of reusable intermediate and high risk Medical devices Management of specific micro-organisms e.g. MRSA, Clostridium difficile Occupational health and safety policies for example - sharps, needle stick injury and body fluid exposure management policy and procedure inclusive of HIV post-exposure prophylaxis 3.0 Organisational Responsibilities The Chief Executive has ultimate responsibility for the implementation and monitoring of the policies in use in the trust. This responsibility may be delegated. The Director of Nursing, Performance and Quality will take the lead responsibility for the development and implementation of this policy with support of the Lead Nurse, Infection Prevention and Control, and the Infection Prevention and Control Doctor. Standard Precautions Policy November 2017 Page 4

5 The Director of Infection Prevention and Control (DIPC) will oversee the implementation of this policy, in addition to challenging bad practice. Providing assurance to the board that systems and process are in place to ensure compliance with agreed standards. The Infection Prevention and Control Team (IPCT) will have responsibility for ensuring the policy is implemented and monitored across the trust. In addition they will ensure compliance with any national initiatives or directives; providing and supporting a sustainable programme of audit and education across the health economy. All Employees must ensure they are compliant with Infection Prevention and Control training, standards and policies which are monitored through the appraisal process 4.0 Processes and procedures Definitions Standard Precautions Personal Protective Equipment (PPE) Bodily fluids Moist body sites Measures that underpin Infection Prevention and Control (IPC) in daily practice. These are the basic IPC measures required to reduce the risk of transmission of infectious agent(s) from both recognised and unrecognised sources of infection in order to ensure the safety of patients, staff and visitors throughout the healthcare setting. Equipment which is intended to be worn or used by healthcare workers to promote patient and personal safety against infection risks e.g. gloves / aprons / eye protection / masks For example (this list is not exhaustive): Blood Blood stained body fluids / substances Cerebrospinal fluid Faeces Saliva in association with dentistry Sputum Urine Vomit For example (this list is not exhaustive): Open wounds Non-intact skin Entry / Exit sites of invasive devices Mucous membranes Hand hygiene for specific guidance please read East Cheshire NHS Trust hand hygiene policy: %20policy%20April16.pdf Element Hand hygiene is critical to prevent the transmission of infection. It must occur at the point of patient care in accordance with the WHO (2009) Five Moments of Hand Hygiene All staff must undertake training in hand hygiene as part of their mandatory training. Standard Precautions Policy November 2017 Page 5

6 Indication for hand hygiene with liquid soap and water (this list is not exhaustive). Hand decontamination using alcohol based sanitiser (this list is not exhaustive). Alcohol based sanitiser can be used on socially clean hands When hands are visibly dirty Following removal of gloves Following handling of blood or bodily fluids Following microbial contamination (e.g. during wound examination, wound dressing, sputum aspiration) Before performing an aseptic non-touch technique (ANTT) procedure Before preparing, handling or eating food After patient toileting / visiting the toilet Following care of patients with symptomatic diarrhoea and / or vomiting On entering and leaving the clinical environment Between social patient contact e.g. ward rounds Prior to handling patient equipment Before and after transfer of patients from / bed / chair / trolley Personal Protective Equipment (PPE) PPE is worn in addition to uniforms and normal clothing and must be utilised to protect both the patient and the healthcare worker from the potential risks of transmitting infection. PPE reduces the risk of transferring microorganisms between patients, carers, staff and equipment. It is important to note that standard uniforms are not classed as PPE. The following risk assessment must be considered when making a decision regarding PPE use: No risk of exposure to blood or bodily fluid Blood / bodily fluids - low risk of splash or contamination Blood / bodily fluids - high risk of splash or contamination No PPE required Disposable single use aprons and gloves Disposable gloves / plastic aprons / eye protection / face masks / visors / impervious gowns The following items must be available for staff to access in all clinical areas Gloves (sterile / non-sterile) in a variety of sizes Aprons & fluid repellent gowns Goggles / face visors (face and eye protection) Masks. Gloves Element Gloves - single use items. Can reduce the potential of acquiring infection through direct skin contact between healthcare workers and patients. This is not a substitute for appropriate hand hygiene, prolonged and indiscriminate use may lead to skin Gloves are a single use item Gloves must be worn when direct contact with blood, bodily fluids, non-intact skin or mucus-membranes is anticipated Gloves must be changed between patients and prior to different procedures being performed on the same patient. Gloves can reduce the likelihood of contact Standard Precautions Policy November 2017 Page 6

7 irritation (WHO 2009) Gloves must be disposed of into the appropriate waste stream When to wear gloves Sterile gloves - sterile gloves reduce the likelihood of transmission of microorganisms from the health care worker s hands to the patient during sterile and invasive procedures (Damani 2012). Heavy duty plastic gloves - as worn by Estates teams dermatitis for staff exposed to chemical agents Hands must be decontaminated with liquid soap and water immediately following removal of gloves Gloves MUST NOT be worn when answering the phone or using computer keyboards. Venepuncture / cannulation procedures Wound inspection Aseptic Non Touch Technique Emptying urinary catheter bags / stoma bags When using chemicals Cleaning equipment / environment IV drug administration Invasive procedures Contact with body fluids Surgical procedures use sterile gloves Training on the correct procedure for donning and removal of sterile gloves must be provided for staff to prevent the contamination of the outer surface of the glove and the hands. Are required for all dirty jobs, e.g. work on sluices, drains, water taps, sinks, toilets, bedpan washers, exhaust protective cabinets, main incinerator, waste disposal, dirty linen areas (only if it is necessary to have direct contact with loose, fouled and soiled linen) and contaminated equipment. On occasion, vinyl disposable gloves may be more appropriate. Gloves used for tasks involving liquids, e.g. water, must be made of strong waterproof fabric (irrespective of time of year) and must be long enough to avoid water entering the glove Adverse reactions to gloves Storage of gloves Staff members who feel they are experiencing an adverse reaction to the gloves they are using must contact Occupational Health who will investigate further. Gloves must not be stored in the sluice. Gloves used at a patient s bedside must be disposed of following patient discharge to prevent transmission of micro-organisms. Standard Precautions Policy November 2017 Page 7

8 Aprons / Gowns Element A single use disposable plastic apron must be worn to reduce contamination of uniforms / clothing and protect patients and staff when: Undertaking direct patient care Cleaning the environment or equipment The potential for transmission of pathogens exists The potential exists for splashes from fluids / chemicals / medications Renewal of aprons The type of apron worn will be dependent on the task for example: Green Apron handling food Yellow Apron caring for patients with suspected or confirmed infections Red Apron cleaning bathrooms, toilets White Apron - general purpose Blue Apron ANTT procedures Aprons must be renewed between patients and prior to undertaking different procedures on the same patient e.g. after washing a patient and prior to undertaking a wound dressing. The apron must be disposed in the appropriate waste stream for example as clinical waste in the clinical environment, in a patient s home this may be in the household waste stream. Non-sterile impermeable water repellent gowns are worn Where there is a likelihood of splashing with large amounts of blood or body fluids When providing care for a patient with possible viral haemorrhagic fever Gowns must be removed and replaced after each task or episode of care, and then disposed of as clinical waste. Sterile water-impervious gowns Disposable coveralls These protect patients from infection when they are undergoing surgical or aseptic procedures e.g. insertion of central venous catheters. Disposable coveralls may be used if there is a risk of contamination from chemicals or when providing care for a patient with possible / confirmed viral haemorrhagic fever. Careful attention must be paid when donning or removing coveralls as there is a risk that the clothing beneath the suit may become contaminated. Staff must consult local procedural documents and have received local training on wearing the Standard Precautions Policy November 2017 Page 8

9 Element suits before using them. Eye Protection Element Mucous membranes of the eyes, nose and mouth must be protected when there is a risk of splashes, droplets or aerosols of blood or body fluids. Eye protection may be achieved through the use of goggles, visors or face shields. They must be comfortable to wear, fit correctly and allow for clear vision. Eye protection must be available in all clinical areas Eye protection must be single use and disposed of as clinical waste Reusable eye protection must be decontaminated after each use and stored in a clean environment Care must be taken when removing eye protection to prevent contamination of hands and other surfaces Face Masks / Respirators - Masks are worn to protect the user from potential exposure to microorganisms via splashes of blood or body fluids. Element The use of a mask must be based on an assessment of risk of body fluid exposure: Surgical face masks protect the wearer from expelling droplets (>0.5 microns) into the environment. If the mask is fluid resistant, the wearer will be protected from splashes. Masks are rarely worn in general ward environments. However specific infections may require the user to wear one e.g. when caring for patients with respiratory illnesses such as suspected or confirmed Influenza, TB etc. Respirators are made to specific standards EN , FFP2, FFP3. Selection of masks Selection of the appropriate mask is required to ensure protection is adequate Clinical staff must have undertaken specific training prior to using an FFP3 mask If required, masks must be applied prior to entering the single room / isolation room Masks must be close fitting and worn correctly Masks must be changed between operations / patients Masks must be changed immediately if they become wet Masks must be disposed of immediately following the procedure into the clinical waste stream. Waterproof footwear Standard Precautions Policy November 2017 Page 9

10 Element This may be required if there is a probability of exposure to a large amount of blood, body fluids, or bodily substances e.g. orthopaedic surgery, estates workers accessing drains, overflowing bedpan washer. The footwear must protect the user from exposure to the liquid contaminant. For example, calf length wellingtons provide more protection than clogs or overshoes. Waterproof footwear must be changed at the end of a task / procedure, between patients or at the end of a clinic session. Estates workers only There is no need to clean the outside of the wellingtons unless contaminated with faecal matter, or visibly soiled For removal of simple dirt wash with detergent and water, dry and store For removal of faecal or contaminated matter. Wearing PPE clean footwear using a disposable cloth, detergent and hot water. Taking care to avoid generating water aerosols If the footwear is re-usable then decontaminate according to manufacturers instructions. If fabric parts of the footwear (e.g. inner lining of a boot) become contaminated the footwear must be disposed of as clinical waste Disposable waterproof footwear is rarely used but must be disposed of immediately after use. Please Note: Hands must be washed with liquid soap and water after removing PPE. Estates Workers Estates workers must ask the person in charge of a clinical / community area if extra precautions are required from an infection prevention perspective when attending the area. This helps to inform estates staff if it is unsuitable for them to enter a restricted area, e.g. during an outbreak, or to support and assist estates staff to wear the appropriate PPE e.g. FFP3 masks whilst undertaking essential work. Please note, the person in charge of the clinical area cannot to inform estates worker(s) specifically what organism the patient has been diagnosed as having, as this would breach patient / client confidentiality. Blood and Bodily Fluids Spillage Any blood and body fluid spillages are to be cleaned with a hypochlorite based solution e.g. Haz TAB/HAZ TAB granules (NaDCC) Sodium Dichloroisocyanurate, because blood and bodily fluids can contain harmful pathogenic micro-organisms. Haz-Tabs must be stored as per COSHH guidelines; wherever possible use these agents in a well ventilated area. Protective clothing, e.g. gloves and apron, must be worn when dealing with blood / body fluid spillage. The area must be made safe to prevent further contamination and protect staff and patients. The chlorine solution should be made up as per manufactures instructions using the Haz tab dilution bottle to mix the solution. The solution must be made up fresh every 24 hours; and unused solution must be discarded after 24 hours. Blood / body fluid spillage can be divided into groups: Standard Precautions Policy November 2017 Page 10

11 Soiling of equipment or where it is not practicable to use a hypochlorite powder e.g. splashes and drips. Spillage on the floor or large surface areas. s to take following blood / bodily fluids spillage. Please note it is not appropriate to use hypochlorite on carpet or soft furnishings as this may damage the fabric. Element Blood and bodily fluid spillage (no matter how small). Use PPE, this must include gloves and aprons to prevent contamination of clothing. Face protection may be required if it is suspected that splashes may occur to the eyes, nose or mouth. Mop up excess fluid with paper towels, leave towels on spillage. Gently pour the HAZ-TAB solution over the spillage (ensure all the blood spillage is covered) and leave for a minimum contact period of 2 minutes (to kill blood borne viruses) ensure that the area is well ventilated and cordoned off if necessary to prevent slips / falls. After a minimum of 2 minutes wipe up/mop up the area (dependent on the size of the spillage). Clear away towels / disinfectant / granules from the area, place immediately into a lined and lidded waste bin. Wash the area with water and allow drying. Dispose of used equipment and PPE in appropriate clinical waste bin. Decontaminate hands using liquid soap and water. Body fluids, e.g. vomit, urine, faeces Use PPE this must include gloves and aprons. Wipe up the fluid with absorbent paper soaked in freshly prepared chlorine solution (1,000 ppm available chlorine solution). Clear away spillage with paper roll. Wash area with detergent and water using paper roll Dispose of used paper roll in an Standard Precautions Policy November 2017 Page 11

12 orange clinical waste bin Dispose of PPE in clinical waste bin Decontaminate hands using soap and water Waste Disposal for specific guidance please read East Cheshire NHS Trust waste policy All waste must be segregated at the point of use. Bag type Contents of bag Additional guidance Black bag General waste e.g. used paper towels following hand washing, packaging etc. Clear plastic bags Orange bag Tiger striped bags Yellow bag Hazardous waste Sharps bins Waste for recycling i.e. paper, cans, plastic bottles and containers. Clinical waste for treatment - chest drains, suctions canisters items that have been in contact with blood and bodily fluids from an infected source. No medicinal waste including used IV bags, giving sets etc. Offensive waste suitable for landfill items that have been in contact with blood and bodily fluids. Human waste, incontinence pads, urinary catheter and stoma bags, nappies, sanitary waste, nasal secretions, sputum, dressings, wipes, gloves, urine bags and vomit Clinical waste with a chemical or medical contamination plaster cast, items that have been in contact with blood and bodily fluids and are contaminated with chemical or medicinal waste Solvents, chemicals, aerosols, gas cartridges, chemicals, oils, batteries, inkjet and toner cartridges, tyres, fluorescent tubes and compact fluorescent lights (CFLs), mercury, sodium lamps, waste electrical and electronic equipment (WEEE) Yellow lidded sharps bin mixed sharps and pharmaceuticals. Needles, syringes, glass vials and small amounts of broken glass not contaminated with cytotoxic or cytostatic medicines Bags must be closed using the swan necked method and tied with a coded zip tie. Bags must be closed using the swan necked method and tied with a coded zip tie. These must be disposed of separately, arrangements must be sought through the Waste Contract Performance Manager The trust uses two types of sharps bins. - single use sharps bins and - reusable sharps bins (used within the main hospital site but not community settings). Standard Precautions Policy November 2017 Page 12

13 Bag type Contents of bag Additional guidance Orange lidded sharps bin nonmedicinally contaminated sharps suitable for alternative treatment. Sharps not contaminated with medicinal products e.g. phlebotomy needles and blood collection vials Purple lidded sharps bins cytotoxic and cytostatic waste. Sharps e.g. needles, syringes, blades or glass vials contaminated with cytotoxic or cytostatic medicines Red sealed unit Pharmacy waste Microbiological samples / Cultures Infectious healthcare anatomical waste for incineration. Infectious healthcare waste including placentas and other recognisable anatomical waste. Blue sealed unit out of date stock, ward or patient returns (not cytotoxic or cytostatic) in inner packaging, remove outer packaging. Yellow lidded sealed unit live microbiological samples / cultures, live vaccines, category 3 infectious materials (triple packaging required), large volumes of bodily fluids Staff must have the appropriate training and be aware of the correct waste disposal procedure prior to handling clinical waste. Sharps Sharps are defined as any object in the healthcare setting that could puncture the skin and permit the entry of bacteria or viruses into the body. Employers have a legislative requirement (HSE 2013) to ensure that a suitable risk assessment is undertaken, and that as far as is reasonably practicable either an alternative to the use of sharps is considered, or a safety device used. A safety device must have been assessed to ensure its suitability for the required task and to ensure that each patient s safety is not compromised. Sharps are defined as (this list is not an exhaustive) - needles, scalpels, suture needles, lancets, scissors, surgical instruments, stitch cutters, glass ampoules, vacuum blood collecting systems, fragments of bone and teeth. Community sharps If sharps are used infrequently in a dedicated domiciliary setting by community staff, they should carry their own sharps bin with them. This must have the temporary closure mechanism in place when not in use. If community staff are using sharps on a regular basis in a patient s home, it may be appropriate to have a dedicated sharps bin retained in the home. The patient / relatives and community staff must consider the size of the container required and identify a suitable place to store it. The patient, family and / or carers must be given information on the safe handling of sharps and storage of the sharps container. If the patient does not wish to have the container in their home, or a risk assessment is undertaken which identifies it would be Standard Precautions Policy November 2017 Page 13

14 inappropriate to leave a sharps bin in the patient s home, then the community staff will have to continue bringing their own sharps bin on each visit. Community staff must transport any sharps containers in a suitably rigid, washable lidded container to reduce the risk of spillage, and it must be ensured that the temporary closure mechanism is in place at all times when not in use. Patient s own sharps bins (used by the patient / family and not the community staff) must be taken to the local pharmacist for disposal and must not be transported for disposal by community staff as they are not licenced to undertake this task. Community staff must dispose of sharps containers as clinical waste, they must be stored in a designated clinical waste area which must be lockable and secure. Containers must be stored upright. Storage facilities must be available at each base / place of work to avoid unnecessary handling and transportation of containers. Sharps Injuries - This must be read in conjunction with Occupational Health - Sharps, Needle stick Injury and Body Fluid Exposure Management Policy and Procedure Inclusive of HIV Post-Exposure Prophylaxis ECT An inoculation injury occurs where a needle or other sharp object contaminated with blood or other body fluid penetrates percutaneously (through the skin). Such injuries also include cuts, scratches, bites etc which break the skin and splash body fluids to the mucus membranes eyes, nose and mouth, see appendix1. The most common sharps injury in healthcare setting is generally referred to as a needle stick injury. When incidents occur they must be reported immediately to the person in charge of the clinical area. Suitable first aid must be undertaken as per Occupational Health guidance (see appendix 1), in addition a DATIX incident form must be completed electronically and the line manager informed. Preventing innoculation injury In order to reduce the potential risk for an inoculation injury to occur staff must use sharps in a safe manner: Undertake mandatory Infection Prevention and Control training either face to face or via e- learning Use appropriate PPE including gloves and aprons Take a sharps bin to the point of patient care and discard used sharps directly into the sharps bin following use Under no circumstances re-sheath needles Not use plastic trays to carry exposed sharps, never carry loose sharps in your hand Ensure the temporary closure mechanism is in place when transporting sharps bins and when not in use Ensure that sharps bins are not filled above the ¾ mark level of the bin Ensure sharps bins are stored securely off the floor and away from vulnerable people e.g. children, confused patients. Linen Element Used linen is a potential source of infection as it may become contaminated by potentially pathogenic organisms Gloves and aprons must be worn when handling linen that has been used, is soiled, wet or bodily stained linen. Linen must be placed into an appropriate coloured linen bag at the patient s bedside. Linen bags must be placed in linen skips and never carried by hand for disposal Do not overfill linen bags Standard Precautions Policy November 2017 Page 14

15 Element Linen from infected patients or stained with bodily fluids must be placed in a red dissolvable bag and placed in a white linen bag. When handling linen take care not to disperse skin cells into the atmosphere i.e. don t shake linen. Patient s laundry to be taken home should be placed in a dissolvable bag which can be placed in a washing machine then washed on the hottest temperature the fabric can tolerate. Within the patient s own home they should be advised to wash soiled linen separately from other clothing at the hottest temperature the fabric can tolerate. Decontamination of Equipment (this must be read in conjunction with the Decontamination of reusable intermediate and high risk Medical devices and Trust cleaning policy) Reusable equipment can be a potential source of infection if not appropriately decontaminated after each use. Cleaning is an essential stage in the decontamination process and must always precede disinfection and / or sterilization. Selection of the appropriate decontamination method will ensure that the equipment is clean and fit for purpose. This process must be undertaken in line with manufacturer s instructions to ensure suitable cleaning agents are used, this must be considered as part of the purchasing process. The user of the device is responsible for ensuring that it is visibly clean and free from contamination with blood / body fluids following each procedure, prior to re-use and prior to sending for repair (internally / externally). Following completion of the cleaning process an I am clean sticker or tape must be attached to the device to identify cleaning has taken place. This must include the date and legible signature of the person undertaking the clean. PPE must be worn, if there is a risk of splashes suitable face protection must be worn. This is to protect the healthcare worker from exposure to microorganisms or infectious agents. During decontamination, the user must check clinical equipment for signs of damage and send for repair or disposal if appropriate. As part of this process a completed label must be attached to confirm that a suitable level of decontamination has occurred as per the trust Decontamination of medical and laboratory equipment prior to maintenance or transportation policy. Staff immunisation / illness All new employees to East Cheshire NHS Trust are required to discuss their immunisation status with Occupational Health. In addition, existing staff have a responsibility to ensure they maintain their immunisations and inform Occupational Health accordingly. The trust will offer all staff an annual flu vaccination as part of the national campaign to reduce the risk of influenza. Standard Precautions Policy November 2017 Page 15

16 Employees have a responsibility to report sickness and absence in line with the appropriate policy to ensure their patients and colleagues are protected accordingly. Staff reporting with illness relating to an identified outbreak will be asked to submit samples and requested to remain absent from work for an identified period of time for example 48hrs after the last onset of symptoms for diarrhoea and / or vomiting. If the illness relates to any of the following individuals must report to occupational health department, who will provide the appropriate advice, this list is not exhaustive: - Skin rashes - Respiratory problems e.g. influenza - Clostridium difficile / MRSA / CPE / VRE - Vomiting and / or diarrhoea - Herpes simplex - Dermatological conditions e.g. eczema 5.0 Monitoring Compliance with the Document All clinical staff must undertake Trust infection control mandatory training annually. Additional training on IPC specific organisms management will be provided by the IPCT. The infection prevention and control team will review and investigate reported incidents relating to this policy, and audit departments / clinical areas compliance against policy requirements. Non-compliance with the policy will be managed via the HR disciplinary route; this will be supported by the Director of Nursing, Quality, Performance, DIPC, and the Medical Director. Standard Precautions Policy November 2017 Page 16

17 6.0 References Damani, N. (2012) - Manual of Infection Prevention and Control. Third edition. Oxford: Oxford University Press. Department of Health (2008) - The Health and Social Care Act Code of Practice on the prevention and control of infections and related guidance (updated 2015). London: Department of Health. Care Quality Commission (2017) available from: [online]. Last accessed Health and Safety at work Act etc. (1974) available from: [online]. Last accessed Loveday H.P. et al (2014) - epic3: National Evidence-Based Guidelines for Preventing Healthcare-Associated Infections in NHS Hospital in England. Journal of Hospital Infection 86S1 S1- S70. Available from: Based_Guidelines_for_Preventing_HCAI_in_NHSE.pdf [online]. Last accessed World Health Organisation (2009) - WHO Guidelines on Hand Hygiene in Health Care. First Global Patient Safety Challenge Clean Care is Safer Care.Geneva. WHO. Available from: [online]. Last accessed Standard Precautions Policy November 2017 Page 17

18 Appendix 1 - Sharps injuries flowcharts Standard Precautions Policy November 2017 Page 18

19 Standard Precautions Policy November 2017 Page 19

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