Standard Infection Prevention and Control Precautions

Publication: 01/06/2000  --
Last review: 12/10/2018  
Next review: 12/04/2022  
Clinical Guideline
INTERIM REVIEW DATE 
ID: 671 
Approved By: Trust Clinical Guidelines Group 
Copyright© Leeds Teaching Hospitals NHS Trust 2018  

 

This Clinical Guideline is intended for use by healthcare professionals within Leeds unless otherwise stated.
For healthcare professionals in other trusts, please ensure that you consult relevant local and national guidance.

Standard Infection Prevention and Control Precautions

 

Summary of Guideline/Protocol

Standard infection prevention and control precautions evolved in response to the risk of transmission to healthcare staff, patients, visitors and the environment of harmful micro-organisms from the body fluids of patients whose infection status is unknown.
This guideline gives the elements of the Standard Infection Prevention and Control Precautions that must be taken by Leeds Teaching Hospitals Trust (LTHT) employees in order to protect themselves, patients, visitors and the environment from contamination by harmful micro-organisms

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Management

Standard infection prevention and control precautions are the measures that must be taken by ALL LTHT staff at ALL TIMES when in contact with body fluids.

These measures assume that ALL body fluids are contaminated with harmful micro-organisms and that the immediate environment may also be contaminated.

When choosing which standard infection prevention and control precautions are put in place, a risk assessment of the task to be undertaken and the risk of contact the staff member has with body fluids should be undertaken (Appendix A).

Standard infection prevention and control precautions are

  • Correct hand hygiene
  • Correct use of personal protective equipment (PPE)
  • Inoculation injury prevention and actions to be taken following such an injury.
  • Safe disposal of body fluid spillages.
  • Safe disposal of waste.
  • Safe disposal of used linen.

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Hand hygiene

Hands should be decontaminated before and after any contact with patients and their immediate environment refer to LTHT Hand Hygiene policy

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Can I eat and drink at the patient's bedside?

Due to the potential of environmental contamination, and the necessity to ensure compliance with LTHT Hand Hygiene policy, eating and drinking is not allowed in the immediate patient environment.

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Personal protective equipment (PPE)

  • The use of PPE is essential for health and safety.
  • PPE protects the patient and the healthcare worker
  • A risk assessment (Appendix A) must be carried out to establish the level of PPE required for any patient care activity.

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Inoculation injury prevention - safe handling and disposal of sharps (Appendix C)

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Disposal of waste, used linen and excretia

  • Linen does not need to be changed daily however;
  • If linen is visibly soiled it should be changed
  • If a patient is source isolated, bed linen should be changed daily.
  • If patient has a skin condition such as skin shedding, wounds, or invasive devices, pressure sore etc then bed linen should be changed daily.
  • Dispose of all waste as per LTHT Waste Policy.
    See appendix E.
  • Place linen contaminated with body fluids into water-soluble alginate bags and then into laundry bags for safe transportation to the laundry.
  • Dispose of any excreta not passed down the toilet directly into the bedpan macerator.
  • For source isolated patients refer to LTHT Source Isolation Policy.
  • To view the LTHT side room risk assessment please click the link below.

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Disposal of body fluid spillages

The Department of Health recommend chlorine (sodium dichloroisocyanurate) for decontamination purposes following ALL body fluid spillages.

  • Spillages of high risk (Appendix B) body fluids
    Chlorine in the form of granules and tablets (e.g. HazTab granules/tablets or Biohazard Kit) for decontamination following spills of high risk body fluids provides chlorine at a 10,000 parts per million (ppm) strength. Please follow the manufacturer’s instructions carefully and ensure that the correct contact time is achieved. This allows for the deactivation of any potential Blood Borne Viruses
  • Spillages of low risk (Appendix B) body fluids
    Following absorption of the low risk body fluid spillage using paper towels the area must be decontaminated using chlorine at a strength of 1000 ppm (e.g. Chlorclean) If visible blood is present in low risk body fluid spillages use chlorine 10,000 ppm.

NB Chlorine must not be used directly on urine or vomit as chlorine gas may be released - If blood is visible in the urine spill, soak up with paper towels and dispose of in a clinical waste bin- then use chlorine at a 10,000 parts per million (ppm) strength.

  • If no visible blood then soak up with paper towels and dispose of in a clinical waste bin- then use chlorine at strength of 1000 ppm (e.g. Chlorclean).

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Infection prevention and control following patient death

Harmful micro-organisms can continue to thrive following the patient’s death and may be present in any blood or body fluid leakage. Standard infection prevention and control precautions taken when the patient was alive should therefore be continued during last offices.

To minimise the risk of blood or body fluid leakage all orifices must be packed. All wounds, intravenous sites or breaks in the skin must be sealed with an occlusive dressing. If a peripheral intravenous cannula or central venous catheter is left in situ it must be capped off. If a body is expected to leak blood or body fluids beyond the capacity of the packing the body must be placed in a body bag.

Body bags are used for high risk patients as per Appendix D and if body leakage is anticipated as described above.

It is important that mortuary staff are informed where there is a risk of infection
Ensure that the mortuary card has a yellow ‘Danger of Infection’ label attached to it
Ensure that the mortuary card defines the nature of the infection (HSAC 2003).

All enquiries by mortuary staff about any potential risk should be directed to the patient’s medical staff.

Outside the hours of 0830 - 1700 at Leeds General Infirmary and 0800 - 1600 at St James University Hospital the portering staff should place a yellow ‘Danger of Infection’ sticker on the door of the refrigerated store unit in which the body has been placed.

Religious and Cultural considerations - There are considerable variations according to religion and culture regarding practices for death and dying. If there is a need for involvement of non LTHT staff those persons will need to be informed of any risks of infection and advised of control measures that should be used.

Viewing by relatives - For patients with known high risk infection, viewing of the body should take place on the ward prior to putting the body into a body bag, even if this necessitates keeping the body on the ward for longer than usual. Once the body has left the ward, viewing may be more distressing for relatives due to the effects of the body bag on the body, and more difficult to arrange if the funeral director adheres strictly to infectious diseases regulations. When relatives wish to view the body they will need to be advised of any risk of infection if they touch or kiss the deceased. Relatives must be informed of any precautions they need to take following contact e.g. hand hygiene.

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Appendix A - Assessment of patient care activity

NB Source isolated patients require PPE as per LTHT Isolation Policy

No Risk of exposure to blood or bodily fluid

No Protective Clothing
(Aprons should be worn for bed making to reduce contamination of clothing by skin commensals)

Blood/body fluid - low risk of splash, (for example toileting a patient, removing or inserting a cannula).

Disposable single use aprons and Gloves

Blood/body fluid -
high risk of splash, ( for example, endoscopy, some dental procedures, large abscess drainage).

Disposable Gloves/plastic aprons/eye protection/face masks/ water resistant gowns

Choosing gloves- when choosing which glove size to wear please ensure that the gloves fit to the skin and around the wrist- without causing discomfort due to tightness. Gloves should be changed between each task and hands decontaminated between.

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Appendix B - Body fluids defined

Blood borne viruses may be present in blood and other high-risk body fluids that should be handled with the same precautions as blood.

High-risk body fluids include:

  • cerebrospinal fluid
  • peritoneal fluid
  • pleural fluid
  • pericardial fluid
  • synovial fluid
  • amniotic fluid
  • semen
  • vaginal secretions
  • breast milk

any other body fluid or unfixed tissue or organ containing visible blood,(including saliva in dentistry).Body fluids that do not need to be regarded as high risk for blood borne viruses, unless they are visibly blood stained are:

  • urine, faeces, saliva, sweat, vomit

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Appendix C - Safe handling oand disposal of specimens

  • Needles must never be bent or broken
  • Never pass sharps from person to person
  • Never walk around with sharps in your hand
  • Always get help when using sharps with a confused or agitated patient
  • Always use needle free devices wherever possible
  • Always dispose of sharps yourself
  • Dispose of sharps at the point of use (take a sharps bin with you)
  • Dispose of syringes and needles as a single unit (do not remove the needle first)
  • All sharps must be disposed of in a sharps bin
  • Always ensure sharps bins are assembled correctly (ensuring that the lid is secured properly, the label is completed )
  • The sharp on an IV giving set should not be disconnected from the tubing to minimise the risk of incurring a sharps injury.
  • Ensure that sharps bins are placed in a suitable safe location (wall and trolley brackets should be used as appropriate).Sharps bins should never be placed on the floor. Risk assessments should always be made for confused patients or children.
  • Ensure sharps bins are of an appropriate size for the clinical activity
  • Sharps bins should be available at the point of use of the sharp
  • Never overfill a sharps bins
  • All sharps bins to be closed securely when ¾ full or at the specified interval
  • Between uses the temporary closure device should be employed to prevent accidental spillage of sharps if the bin is knocked over
  • Always carry the sharps bin by the handle, or using the tray provided; never place it against your body
  • Ensure sharps bins are locked in accordance with manufacturer’s instructions and ensure they are labelled with point of origin. Do not place sharps containers in yellow or orange clinical waste bags for disposal.
  • Used sharps bins must be stored in a locked, segregated designated cupboard or clinical waste storage bin

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Appendix D - High risk organisms requiring a body bag after death

Infection

Causative agent

Is a body bag needed

Can the body be viewed

Can last offices be carried out

Dysentery

Bacterium - shigella dysenteriae

Advised

Yes

Yes

Hepatitis A

Hepatitis A virus

No

Yes

Yes

Typhoid /Paratyphoid fever

Bacterium- salmonella typhi/paratyphi

Advised

Yes

Yes

Human immuno-deficiency virus

Human immuno-deficiency viruses

Yes

Yes

Yes

Hepatitis B and C

Hepatitis B and C
viruses

Yes

Yes

Yes

Tuberculosis

Bacterium-mycobacterium tuberculosis

Advised

Yes

Yes

Meningococcal
Meningitis

Bacterium- Neisseria meningitidis

Advised

Yes

Yes

Non meningococcal meningitis

Various bacteria including haemophilus influenzae and also viruses

No

Yes

Yes

Diphtheria

Bacterium- corynebacterium diphtheriae

Advised

Yes

Yes

Respiratory viruses

Restricted to Severe acute respiratory syndrome (SARS) and Influenza A subtype H1N1 (Swine Flu)

No unless risk of leakage of body fluids

Yes

Yes

Invasive streptococcal infection

Bacterium-streptococcus pyogenes (group A )

Yes

Yes

Yes

Meticillin resistant staphylococcus aureus

Bacterium- meticillin resistant staphylococcus aureus

No

Yes

Yes

Viral haemorrhagic fevers

Various viruses, e.g. Lassa fever virus/Ebola virus

Yes

No

No

Transmissible spongiform encephalopathies

Various prions e.g. Creutzfeld Jacob disease (CJD)/Variant CJD

Yes

Yes

Yes

Adapted from Health and Safety executive Guidance (2005) controlling the risks of infection at work from human remains

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Appendix E



Provenance

Record: 671
Objective:

Aims

To protect LTHT staff, patients, visitors and the environment from contamination by harmful micro-organisms that may be present in body fluids

Objectives

  • For LTHT employees to be aware of what standard infection prevention and control precautions are.
  • For LTHT employees to be aware of the standard infection prevention and control precautions that must be taken in the event of body fluid spillages.
  • For LTHT healthcare workers to be aware of the standard infection prevention and control precautions that must be taken following the death of a patient in order to minimise body fluid leakage and the potential transmission of any harmful micro-organisms.
Clinical condition:
Target patient group: All patients within the LTHT secondary care setting
Target professional group(s): Secondary Care Doctors
Secondary Care Nurses
Adapted from:

Evidence base

Centres for Disease Control (1987) Recommendations for the Prevention of HIV Transmission in Health Care Settings. MMWR (Aug.21) 36: (2S).

Department of Health (2008), Health and Social Care Act: Code of Practice for the Prevention and Control of Health Care Associated Infections. HMS Crown Printing

Expert Advisory Group on Aids and the Advisory Group on Hepatitis HMSO London

EPIC 3 (2013): National Evidence-Based Guidelines for Preventing Healthcare-Associated Infections in NHS Hospitals in England H.P. Lovedaya, J.A. Wilsona, R.J. Pratta, M. Golsorkhia, A. Tinglea, A. Baka, J. Brownea, J. Prietob, M. Wilcoxc

Gerberding JL Management of Occupational Exposures to Blood Borne Viruses. New England Journal of Medicine Vol 332, No 7, Feb 16th 1995

Guidance for Clinical Health Care Workers (1998) Protection Against Infection with Blood – borne Viruses. Recommendations of the Expert Advisory Group on AIDS and the Advisory Group on Hepatitis. UK Health Departments

HIV Post Exposure Prophylaxis (2004) Guidance from the UK Chief Medical Officers' Expert Advisory Group on AIDS. UK Health Departments.

HSAC (2003) Safe Working and the Prevention of Infection in the Mortuary and Post Mortem Room. Health Services Advisory Committee/HSE, London

HSE (2005) Controlling the risks of infection at work from human remains

Infection Control Nurses Association (2003) Reducing Sharps Injury: Prevention and riskmanagement. Bathgate. Fitwise

Health and Safety Executive (2013) Health and Safety (Sharp Interments) in Healthcare
Regulations 2013 - Guidance for employers and employees.

NICE Clinical Guideline (2012) Healthcare-associated infections: prevention and control in primary and community care

Protection Against Infection with Blood-borne Viruses. Recommendations of the ExpertAdvisory Group on AIDS and the Advisory Group on AIDS and the Advisory Group on Hepatitis. HMSO, London.

The Health and Social Care Act 2008: Code of Practice for Health and Social care on the prevention and control of infections and related guidance - Department of Health 2008
The Royal Marsden NHS Trust

UK Health Departments (1998) Guidance for Clinical Health Care Workers:
Protection Against Infection with Blood-borne Viruses. Recommendations of the ExpertAdvisory Group on AIDS and the Advisory Group on AIDS and the Advisory Group onHepatitis. HMSO, London.

Approved By

Trust Clinical Guidelines Group

Document history

LHP version 1.0

Related information

Not supplied

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