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Unit 10
The principles of infection prevention and control
1
About this unit
In this unit learners are introduced to national and local policies in relation to infection
control. Learners gain an understanding of employer and employee responsibilities in
this area and how procedures and risk assessment can help minimise the risk of an
outbreak of infection. Learners will also gain an understanding of how to use PPE
(Personal Protective Equipment) correctly and the importance of good personal hygiene.
The learner will:
1. Understand own and other roles and responsibilities in the prevention and
control of infections
2. Understand legislation and policies relating to prevention and control of infections
3. Understand systems and procedures relating to the prevention and control of infections
4. Understand the importance of risk assessment in relation to the prevention and
control of infections
5. Understand the importance of using personal protective equipment (PPE) in the
prevention and control of infections
6. Understand the importance of good personal hygiene in the prevention and control of
infections
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1.1 Employees’ roles and responsibilities in relation to the prevention
and control of infection
Infection is a major cause of human suffering. Even relatively minor infections can
become more serious, leading to major infection and can, in some cases, lead to a
service user’s death. In addition to their suffering, infection causes distress to family and
friends.
The costs to the health care system of providing care for those with infections are
huge. In addition to concerns over the growing costs to health care, the use of
antibiotics to treat these infections is thought to be contributing towards the problems
surrounding antibiotic resistance.
The NHS plan, published in 1999, stipulates that all NHS organisations should have
effective systems in place to tackle Health Care Associated Infection (HCAI) in order to
minimise the risk to patients/service users and staff. The National Institute of Clinical
Excellence (www.nice.org.uk ) has a set of prioritised statements which are designed to
drive measurable quality improvements within health or care services. Prevention and
control of infections are issues of very great practical importance for every worker
responsible for the health of patients/service users. The Health and Social Care Act 2012
states clear expectation that the care system should considerthe NICE quality standards.
Your place of work will have appropriate guidelines/policies for control of infection and it is
important that you locate and read these and also visit the NICE website and look at the
standards - www.nice.org.uk/guidance/qs61/documents/infection-control-draft-quality-
standard2
Infection control is an issue of health and safety, so is both an employer and
employee responsibility.
An Introduction to Micro-biology
The immune system
The immune system, which is made up of special cells, proteins, tissues, and organs,
defends people against germs and microorganisms every day. In most cases, the immune
system does a great job of keeping people healthy and preventing infections. However
sometimes problems with the immune system can lead to illness and infection.
3
The immune system is the body's defence against infectious organisms and other
invaders. Through a series of steps, the immune system attacks organisms and
substances that invade body systems and cause disease.
Employees’ roles and responsibilities
All employees are responsible for taking action to prevent the spread of infection, in
accordance with legislation and local and organisational policies and procedures. They
also have a personal and moral responsibility, as members of a caring society and
profession.
There are many roles where infection control is important, these include:
Employees who work in communal living environments
Employees who work with hazardous substances
Employees whose work activities may expose them to infection
Employees working with individuals who may be vulnerable to infection.
Employees have responsibilities to:
Self
Colleagues
Employer
Service users/Customers/Patients
Visitors.
4
1.2 Employers’ responsibilities in relation to the prevention and control of
infection
Employers’ responsibilities arise from:
Legal responsibilities
Organisational responsibilities
Personal/moral responsibilities.
Employers’ are responsible for:
Assessing risks
Putting procedures in place
Ensuring procedures are followed
Ensuring employees are appropriately trained in relation to infection control
Making sure employees are aware of the health and safety aspects of their work
- Posting information on notice boards
- Keeping an information file such as Control of Substances Hazardous to
Health (COSHH)
Providing supervision
Keeping records
Ensuring that the relevant standards, policies and guidelines are available
within the workplace.
The Fundamental Standards for Health and Social Care providers state -
Safety - Service users must not receive unsafe care or treatment or be put at risk
of any harm that could otherwise be avoided. Risks must be evaluated during any
care or treatment pathway, making sure your staff have the qualifications,
competence, skills and experience to keep individuals safe
5
Premises and equipment - The premises and equipment used for your care
service must be suitable, secure and looked after/used properly
Good governance - You must have sufficient governance and systems in place to
monitor the quality and safety of care and these must help the service improve and
reduce any risks to health, safety and welfare for your service users.
2.1 Legislation and policies relating to prevention and control of infections
Infection prevention and control guidelines and regulatory body standards
National good practice guidelines set standards and recommendations for all to follow.
An example is the guidelines of Infection Prevention Control in primary and community
settings, from the National Institute for Health and Clinical Excellence (NICE).
Legislation and regulations affecting infection prevention and control
The prevention and control of infection should be a high priority within the health related
setting for many reasons. Not least is the legal responsibility to have a duty of care.
In addition to Infection Prevention and Control Policies there will be other written policies
that interrelate with infection prevention and control and there are normally cross-
references to these in the Infection Prevention and Control Policies. These include:
Safe Handling and Disposal of Sharps
Decontamination Policy
Single Use Item Policy
Disposal of Waste Policy
Blood borne Viral Disease Policy.
6
The Health and Safety at Work Act 1974 and Management of Health and Safety
at Work Regulations 1999
Both employers and employees are responsible for their own actions in the workplace. All
reasonable steps should be taken when carrying out your work duties and all staff should
have adequate health and safety training, and measures should be taken to ensure that
policies and procedures are in place and adhered to. For example, it is the employer’s
responsibility to provide adequate protective equipment and the employee’s responsibility
to use it appropriately.
The Public Health (Control of Diseases) Act 1984
Provides information on the legal requirements for the reporting of contagious or
infectious diseases, for example, Tuberculosis, Hepatitis, HIV and Legionella.
Health Protection Legislation Guidance 2010
The Department of Health has published updated health protection legislation covering
the recently amended Public Health (Control of Diseases) Act 1984. The amendment is
concerned with health protection powers and the requirements of laboratories and
medical practitioners testing human samples.
Food Safety Act 1990
The requirements of this act apply to any area where food is prepared, stored or eaten.
Control is required to ensure that the risks of any infection, as a result of bad handling of
food, are minimised.
Local and central government employ staff to inspect premises without any
advance notice. (Environmental Health Officers).
Food hygiene
In many health care environments, there may be infection control responsibilities under
the Food Safety Act 1990 and the Food Safety Act (General Food Hygiene) Regulations
1995. And subsequent amendments in the Food Safety Act 2005.
7
Under this legislation, workers who handle food must:
Keep themselves and their workplace clean
Wear suitable clean, washable or disposable, protective clothing
Protect food from any possible contamination
Abide by regulations setting out safe temperature controls for storage,
preparation and display of food
Inform their employer of any illness which may affect their safe handling of food.
N.B. These regulations also require that employees who handle food as part of their
normal duties should also undertake specific food hygiene training.
Reporting Injuries Diseases and Dangerous Occurrence Regulations (RIDDOR) 2013
The employer or manager in control of work premises has a responsibility under RIDDOR
to report any work related accidents or disease which result in serious injury or an
employee being “off sick” due to injury for more than seven working days.
The Public Health (Infectious Diseases) Regulations 2001
This describes the reporting systems and the types of disease which must be reported.
Management of Health and Safety at Work Regulations 1999
Requires all staff to be provided with adequate and appropriate training and a set of
working instructions demonstrating ‘safe working practices' for work related
activities.
The Government has produced guidance published by The Health Protection Agency
(2013) ‘Prevention and control of infection in care homes - an information resource - you
may find this useful. It can be found at the following link -
https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/214929/Care-
home-resource-18-February-2013.pdf
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Controls Assurance Standards - Infection Control 2010
This standard provides a framework to control and manage infection. It provides a time
table for senior managers and infection control teams to work to.
The document’s key action areas are:
Strengthen prevention and control of infection
Secure appropriate health care services for service users with infection
Improve surveillance of infection
Monitor and optimise antimicrobial prescribing.
Medicines and Health Care Regulatory Agency (MHRA)
This regulatory body ensures the medicines and products available in the health care
sector are safe to use. The MHRA issue SAFETY BULLETINS if they receive reports of
faulty products or products which may be harmful to health. It is the responsibility of the
health care facility to report untoward incidents or products that are faulty to the MRHA.
Best Practice Guidance
In February 2013, the Government produced some best practice guidance for the
prevention and control of infection in care homes. This resource was intended for home
managers as well as CQC inspectors so that they might have a common source of
information on the subject.
This information resource was developed by the Department of Health (England) and the
Health Protection Agency in conjunction with the Care Quality Commission. It is
important to have clear information available for the families and carers as well as those
receiving the care, so that everyone can be reassured that care is provided in a safe and
clean environment.
This guidance should be read alongside the Code of Practice on the prevention and
control of infection and related guidance from the Department of Health 2010, as part
of the Health and Social Care Act 2008.
The Code sets out the criteria for registration as a care provider and all of the
infection control systems and processes that need to be demonstrated. However,
depending on the circumstances, not all of these will apply to every provider.
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The Health and Social Care Act 2008: Code of Practice can be seen at:
https://www.gov.uk/government/publications/the-health-and-social-care-act-2008-code-of-
practice-on-the-prevention-and-control-of-infections-and-related-guidance
Complianc
e criterion
What the registered provider will need to demonstrate
1 Systems to manage and monitor the prevention and control of infection.
These systems use risk assessments and consider the susceptibility of
service users and any risks that their environment and other users may
pose to them
2 Provide and maintain a clean and appropriate environment in managed
premises that facilitates the prevention and control of infections
3 Ensure appropriate antimicrobial use to optimise patient outcomes and to
reduce the risk of adverse events and antimicrobial resistance
4 Provide suitable accurate information on infections to service users, their
visitors and any person concerned with providing further support or nursing/
medical care in a timely fashion
5 Ensure prompt identification of people who have, or are at risk of
developing an infection so that they receive timely and appropriate
treatment to reduce the risk of transmitting infection to other people
6 Systems to ensure that all care workers (including contractors and
volunteers) are aware of and discharge their responsibilities in the process
of preventing and controlling infection
7 Provide or secure adequate isolation facilities
8 Secure adequate access to laboratory support as appropriate
9 Have and adhere to policies, designed for the individual’s care and
provider organisations that will help to prevent and control infections
10 Providers have a system in place to manage the occupational health
needs and obligations of staff in relation to infection
Other relevant legislation
Learners should have an awareness of legislation and standards as relevant to the
prevention and control of infection and the consequences of not meeting with these
requirements such as:
10
Control of Substances Hazardous to Health(COSHH)
Guidance produced by the Department of Health, National Institute for Health and
Clinical Excellence (NICE), Royal College of Nursing(RCN).
The Environmental Protection (Duty of Care) Regulations1991
Health Protection Agency Bill2004
Hazardous waste regulations2005
The Food Safety (General Food Hygiene) Regulation (Department of Health,1995).
Other new/current legislation that affects infection control.
The responsibilities of the infection prevention and control team
Your organisation will have an infection prevention and control team or representative
(usually the home manager). The members of the team will vary between types of health
care environments, but:
They are responsible for training, education and advising on best practice for
infection prevention and control in your organisation
They are accessible to all staff for advice and guidance on all aspects of
infection prevention and control
The team/person is responsible for writing, implementing and renewing
policies and procedures in relation to infection prevention and control
practice.
Typical infection and prevention control team
The members of the Infection Prevention and Control Team will vary according to the size
of the organisation. In a large unit (Acute NHS Trust) the Infection Prevention and Control
Team will be headed up by a Director of Infection Prevention and Control (DIPC), a
Medical Microbiologist and Infection Prevention and Control Nurses (ICNs) who can give
you guidance on all matters relating to infection prevention and control. ICNs will often
cover specific areas, e.g. hospitals, nursing homes, GPs’ surgeries, and dentists. This
makes it easier to contact a named person and build up a good relationship.
Other sources of information
There is great deal of information regarding infection prevention and control available on
the internet. The Infection Prevention Society (IPS) is an excellent source of information.
Also the Health Protection Agency (HPA) and Health and Safety Executive (HSE)
provide valuable information on this subject, as does the Department of Health (DoH).
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Universal precautions
Universal precautions for the prevention and control of infection include the following
precautions:
1 Hand washing
2 PPE
3 Waste disposal
4 Sharps handling and disposal
5 Safe handling of body fluids
6 Cleaning and disinfection policy
7 Laundering of linen.
Further guidelines and regulations
Other current Government and/or Health Department standards and guidelines
Skills for Health Infection Control workplace competencies
Other national standards and regulations which are current.
2.2 Local and organisational policies relating to the prevention and
control of infection
In addition, there will be local and organisational policies and procedures which will
adhere to and reflect legislation and guidelines:
Health and safety policies
Organisational infection control policies
Any policies specific to role, industry or organisation, e.g. food safety in food related
areas.
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3.1 Procedures and systems relevant to the prevention and control of
infection
In the event that there is an infection outbreak, the nominated Infection Control
Personnel in your workplace will be responsible for notifying the appropriate authorities.
Notification may result in a visit from an Environmental Health Officer (EHO) employed
by the local authority. The role of the EHO is to protect people from environmental health
hazards in their living and working surroundings.
If there has been an infection outbreak, the primary aim of the EHO will be:
To identify the source of infection
To ascertain whether other people are likely to become infected
To provide advice on preventing further spread of the infection.
Measures must always be taken to reduce the risk of infection, and to minimise the
spread of an infection if an outbreak arises.
In the event of a member of staff becoming unwell there are strict guidelines regarding
when that person may attend work. Different infectious diseases can be passed on in
different ways. Most infectious diseases have what is termed an ‘incubation period’. This
is the time when the ill person is most likely to pass their infection on to another person.
The Infection Control Personnel will provide guidance regarding the absence required
from work, in order to minimise the risk of infection spread.
In some instances the ill person may have had contact with other people during the
incubation period, before they realised they were unwell. It is still important to know the
incubation period of a disease, in order to identify how many people may have come into
contact with the infected person, and to assess what the risk of infection spread is likely to
be.
Procedures and systems include:
Risk assessment (including use of PPE and personal hygiene)
Steps taken to reduce the chance of spreading infection
- immunisation, barrier nursing, food hygiene
Surveillance of disease via public health departments
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Organisational procedures
Safe systems of working
Health and safety management systems
Reporting systems.
14
DISEASE INCUBATION PERIOD PERIOD OF
COMMUNICABILITY
MINIMUM RECOMMENDED TIME OFF WORK
MANAGEMENT OF INFECTION
Exclusion guidelines for staff, family and friends
The following table gives guidance on exclusion from work for the more common or important infectious diseases.
DISEASE
INCUBATION
PERIOD
PERIOD OF
COMMUNICABILIT
Y
MINIMUM
RECOMMEND
ED TIME OFF
WORK
MANAGEMENT OF INFECTION
Chicken Pox 15/18 days From one to two
days before and up
to five days after the
rash appears
Five days from
onset of rash
when the spots
are dry
Isolation nursing until spots are dry
Glandular
Fever
28/48 days Prolonged infectivity
but once the
symptoms have
subsided small risk
except from very
close contact
Until clinical
recovery
Personal protective equipment advised
Measles 10/15 days A few days before
to four days after
Four days from
onset of rash
Isolation nursing for up to four days from onset of
the rash
15
onset of the rash
Salmonella 12/72 hours Whilst organism
is present in
stools but mainly
until diarrhoea
has ceased for
24/48 hours
Until diarrhoea
has ceased for
48 hours
Good personal protective equipment and also
limit use of communal facilities
Impetigo Usually 4/10 days but
can occur several
months after
colonisation
Until lesions are dry
or until 48 hours
after starting
antibiotics
48 hours after
starting
antibiotics.
Treatment is
rapidly effective
Personal protective equipment, towels should not
be shared. Observe other service users for signs
of infection
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3.2 Potential impact of infection outbreaks
Effect of infection on the individual
Causes pain and discomfort
Delays recovery
Disrupts and distresses family and the individual
Increases risk of serious illness and death
Unnecessary illness, in some cases leading to death.
Effect of infection on health related settings
Increased length of stay of individuals
Increased use of medication
Increased time and resources while cause investigated
More frequent and return visits by the individual
Disruption to routine
Cost
Cancellation of services and activities
Possible legal action
Loss of reputation.
Effects on Staff
Additional workload
Stress
Possible risk of infection to family
Policies and procedures not being followed effectively due to staff shortages.
EFFECTIVE PREVENTION AND CONTROL OF INFECTION will therefore minimise
the risk of infection meaning that patients/service users can be treated more effectively
and efficiently.
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4.1 Risk
Definitions of Risks and hazards
Hazard - something with the potential to cause harm, death, ill health, injury,
loss of production or damage to plant or property.
Risk - Can be described as the level of probability that someone or something
will be harmed because a hazard exists. This entails the likelihood of injury,
damage or harm arising, taking into account any preventative measures
already in place. A risk is any situation, activity or individual who has the
potential to cause the spread of infection to others.
For instance, a sharp knife left in a washing up bowl is a hazard, receiving a cut from
putting your hand in is the risk; a control measure is not to leave sharp knives in the
bowl.
In the context of a health related setting, the risk of being invaded by an agent
(bacteria, virus, fungi, or parasite) from an internal or external source would be
included.
Hazard identification
In order to achieve a suitable and sufficient risk assessment it is essential to
identify all the hazards associated with the activity.
Monitor work areas and working practices
The less formal way of identifying risks is to be aware at all times of what is going on
around you, and to encourage others to tell you about any risks that they identify.
You can examine the work area for safety and security risks and keep a check on
working practices such as:
Work
activities
Procedures
The use of materials or equipment
Working techniques.
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4.2 Potential risks of infection within the workplace
These risks include:
Risk of illness and death particularly in vulnerable individuals including:
- The very old (immune system is poorer)
- The very young (not yet developed properly)
- Pregnant women
- People with illness or health problem (certain drugs suppress the immune
system)
- People with severe burns
Risk to staff of illness especially those involved in high risk activities, such as:
Caring for/or treating those with infection
Contact with body fluids that may be contaminated.
4.3 Risk assessment
A risk assessment may be defined as an identification of the hazards present and an
‘assessment’ of the extent of the risk involved, taking into account whatever precautions
are already in place.
Health and Safety Executive (HSE) guidance
A risk assessment is simply a careful examination of what, in your work, could cause harm
to people, so that you can weigh up whether you have taken enough precautions or
should do more to prevent harm. Workers and others have a right to be protected from
harm caused by a failure to take reasonable control measures.
Where five or more persons are employed, that assessment must be
written down. There are ‘five steps to risk assessment’:
Identify all the hazards
Decide who could be harmed
Evaluate the risks and decide if existing control measures are adequate and
decide on precautions
Record the findings and implement them
Review your risk assessment and up-date if necessary.
19
During risk assessment, any control measures to limit the risk will have been identified.
Further control measures may be applied following the assessment. It is your
responsibility to check and use risk assessments.
It is vital that before you begin work you check and use any risk assessments. This will
reduce risk and provide protection for all those involved.
The risk assessment process
Identify hazards
Assess risks
Eliminate risks where possible
Reduce risks where they cannot be eliminated
Recording the risk assessment process
Regular reviews of risks to ensure suitable controls are in place
Reporting outbreaks of infectious notifiable diseases
Risk assessment as a continuous process which is the responsibility of
organisations and individuals.
In order to implement effective prevention and control of infection measures within
the health setting employees should use a risk assessment approach. That is to:
1. Assess the risks
2. Decide what precautions are needed
3. Prevent or adequately control exposure
4. Ensure that control measures are used and maintained
5. Monitor exposure
6. Carry out appropriate health surveillance
7. Prepare plans and procedures to deal with incidents and emergencies
8. Ensure employees are properly informed, trained and supervised.
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4.4 The importance of carrying out a risk assessment
It is a requirement of the Management of Health and Safety at Work Regulations to carry out
and document risk assessments. Risk assessment is a proven way to control infection if
implemented properly by staff.
5.1 Demonstrating the correct use of PPE (personal protective equipment)
It is vital, to ensure effective infection control, that all staff are aware of not only the
types of personal protective equipment (PPE), but its correct use.
You must understand and be able to demonstrate when and in what circumstances you
should wear PPE. You should know which PPE to use and be able to demonstrate how
this is worn. This could include, for example, explaining the need to wear a disposable
apron and being able to demonstrate, by your actions, how to wear this correctly and
when it is appropriate to remove.
Disposal will be dealt with further in this unit.
5.2 Types of PPE
Personal protective equipment (PPE) is a term that covers all equipment that is intended
to be worn, or held, by employees and which protects them against one or more risks to
their health and safety.
Gloves
Gloves may be worn for many reasons but do not remove the need for effective hand
washing.
Gloves may be used as a barrier to prevent self-contamination when dealing with body fluids
or chemicals, or to protect skin lesions. They may be used after hand washing in aseptic or
sterile procedures. However, once removed they should be discarded into a clinical waste
bin and hands must be effectively washed and dried.
Gloves are disposable products and should be used for one task/procedure only.
Gloves should be non-powdered latex or vinyl material. However, latex-free or hypo-
allergenic should be made available for staff with latex sensitivity or allergy.
21
Aprons
Although heavy contamination of clothing is not normally seen in most day to day
health related settings, the area at waist height is at most risk, so a plastic, disposal
apron affords good protection. Plastic aprons are waterproof and therefore helpful in
protecting uniforms from moisture during procedures which could involve liquid spillage.
Plastic aprons should be worn whenever there is a risk of bacterial contamination, for
example, during bed making, dirty jobs or isolation nursing.
Blue aprons should be worn in food preparation areas and white aprons in other areas.
An apron should be changed after every task/procedure/every service user contact,
between working areas or after contact with infected individuals.
Masks
Research studies have shown that masks contribute little to infection control in the
general health environment.
They provide protection from staff who have a respiratory infection. However, that member
of staff should be at home until such infection has cleared rather than increasing the risk of
infecting vulnerable individuals.
Micro-organisms are more likely to be spread by improper use of a mask, for example,
constantly touching it. For staff protection from specific contagious infections, procedures
should be in place involving the wearing of masks.
The wearing of a mask is important where there is an increased risk of splashing from
blood or other body fluids.
However, where masks are worn you must follow the guidance given in the organisation’s
infection control policy.
22
Eye protection
Eye protection should be worn during all procedures where there is any risk of splashes or
aerosol spray involving blood or body fluids, e.g. suction procedures such as the taking of
blood.
Types of eye protection that must be available include goggles, visors and face shields.
These should be readily available in the workplace.
5.3 Reasons for use of PPE
PPE is used to protect the individual and others from potential risk of harm.
All users should follow all manufacturer’s instructions and recommendations for use and
should be aware and trained in specific items of PPE by their employer.
When PPE should be used
As recommended by your employer including:
When handling contaminated waste and linen
To prevent cross-contamination when handling food
To protect yourself and others from infectious diseases
To avoid injury, disease and illness.
5.4 Legislation and regulations
Legal requirement in health and safety legislation for the provision and use of
PPE where employees and others may be at risk
Regulations for the use of PPE in infection control.
Relevant legislation
The Health & Safety at Work Act1974
The Management of Health & Safety at Work Regulations1999
COSHH Regulations 2002 (as amended)
The Personal Protective Equipment at Work Regulations 1992 (as amended)
The Control of Noise at Work Regulations2005
The Construction (head protection) Regulations1989.
23
5.5 Employees’ responsibilities regarding the use of PPE
To use PPE appropriately and as instructed by the employer
To check PPE before and after use
To report any damage or wear or other problems
To store in facilities provided for PPE.
Health related workers must wear personal protective equipment (PPE) while
performing some tasks to protect both themselves and their services users from
acquiring infection and to prevent cross-infection between individuals.
PPE should be worn when appropriate according to the organisation’s infection control
policy. However, health related workers must look at the task in hand and ascertain if it
could be carried out in a more effective way in order to reduce risk of cross infection.
5.6 Employers’ responsibilities regarding the use of PPE
Employers are obliged to provide, free of charge, any personal protective equipment
(PPE) that is required by you for the purposes of your job role and to provide training.
Your manager will be able to provide advice and guidance in respect of wearing
protective clothing, related to activities undertaken in your workplace.
5.7 Correct practice in the application and removal of PPE
In order to prevent the spread of infection, cross-contamination and re-contamination,
accidents and injury, it is vital that all staff know:
How to use PPE
The correct application of PPE
The correct removal of PPE
The appropriate PPE for work activity
Correct preparations for use.
5.8 Correct disposal of PPE
Appropriate disposal of single use items, e.g. in clinical/hazardous waste
where appropriate
Preparations of re-useable items for re-use, e.g. sending to the laundry
appropriately labelled in the correct colour-coded bag.
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6.1 The key principles of good personal hygiene
Personal hygiene
Personal hygiene is a very important factor in reducing the risk of infection in the workplace.
There are many other benefits from attending to personal hygiene, such as:
Comfort and relaxation
Warmth
A clean, odour-free and presentable appearance - this maintains self-esteem
and self- respect
Prevention of bacterial and fungal infections.
There are seven normal bodily functions that create the need for hygiene. They are:
Eating
Coughing
Elimination of
urine
Sweating
Drinking
Sneezing
Elimination of faeces.
These bodily functions will mean that certain parts of the body will require particular
attention to prevent discomfort, infection and unpleasant odours.
This will include:
The axillae (armpits) due to sweating - to prevent odours and fungal infections
The groin, pubic and perianal areas, due to sweating and elimination of urine and
faeces, particularly in patients/service users who are incontinent or catheterised -
to prevent skin and genitourinary system fungal and bacterial infections, skin
breaks or sores and unpleasant odours.
Oral hygiene and mouth care
The mouth and teeth require regular and thorough cleaning to reduce the risk of tooth
decay and infection caused by debris associated with eating and drinking. Neglecting
mouth care may result in, not only local infection, but a more generalised systemic
infection. Those who are frail, ill, vomiting or dehydrated will require monitoring and may
need help to attend to their oral hygiene to prevent soreness, fungal infections (e.g.
thrush), gum disease and tooth decay.
25
Clothing
Organisations must have a personal hygiene policy outlining standards for dress and
personal appearance to ensure that staff maintain a hygienic, healthy and safe
environment for service users and themselves.
Uniforms must be clean and free from contamination. They must be regularly laundered at
high temperatures separate from other laundry. This will minimise infection from bacteria
which may be found in the material of the uniform.
Uniforms should only be worn within the workplace, as bacteria from outdoor
soiling, public transport or animals may contaminate uniforms worn on the way to
work.
Staff should change out of workplace uniforms before travelling home because of the risk
of cross- contamination from bacteria collected within the health care setting.
Nails
Nails should be kept short, clean and without polish, decoration or false extensions.
Nails harbour bacteria and the use of a single-use or disposable germ-free nailbrush
should be sought if dirt is ingrained under the nails.
Nail varnish or other decorations are sources of bacterial growth, and contamination of
others is possible if polish or decorations flake or fall off.
Hair
Hair should be kept clean and if long should be worn neatly tied back from the face.
Hairspray and other products should not be used as these can be an irritant to the service
user. Hair should not usually pose an infection control risk if these measures are followed.
Whilst it is not a legal requirement to wear hairnets or hats when preparing food, it is good
practice to do so in a health care environment.
Skin lesions
Any cuts or grazes must be adequately covered with a waterproof dressing. Further
advice must be sought from managers in cases of eczema, psoriasis or other skin lesions
and guidelines adhered to.
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Hair cover
Hats are worn in catering, pharmacy, operating theatres and sterile services departments. If
worn, they should cover the hair completely.
Shoes
Shoes should always be kept clean. For your own protection, you should ensure that
you wear shoes which protect all areas of the feet to protect from spillage of body
fluids. In certain environments specialist shoes and/or disposable shoe covers may be
used (e.g. in operating theatres).
Watches and jewellery
Watches and jewellery should not be worn. Rings and earrings harbour bacteria and do
not allow for effective hand washing. They are also dangerous while handling individuals.
Jewellery should not be worn as it can damage the skin of the service user.
Make-up
Make-up if worn should be minimal to reduce the risk of particles of make-up
falling onto individuals’ wounds as they are being dressed.
Health checks and vaccinations
When employed in a health related setting there are guidelines regarding the minimum
health criteria which must be met to be fit for practice. It is common for a health
screening, or some kind of health checklist to be completed on starting a new post, such
as screening for Tuberculosis (TB), and Rubella and Chickenpox immunity. Usual
requirements are for Hepatitis B, influenza and tetanus vaccinations to be completed and
up to date.
Personal and family illness
When working in a health related environment it is essential that you are fit to perform
your work safely, and effectively, without risk to your own or other people’s health and
safety. Therefore, it is important that workplace policies and guidelines on staff infection
and work restrictions are adhered to.
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Should you or your family be suffering from any kind of infection, advice should be sought
from your GP, Occupational Health Department and/or manager with regard to returning to
work. With regard to viral gastroenteritis infections many employers recommend that you
stay away from work for a further 48 hours after illness has ended to ensure that you are
free from infection. Some employers will ask for further health checks before allowing you
back to work in areas where your illness could put service users at increased risk. It is
important to remember that infections can be carried in the body for weeks after symptoms
disappear and it is important that these infections are not passed on to vulnerable people.
Absence reporting
When requiring time off sick from work it is necessary to observe sickness reporting
procedures and provide details of the nature of illness causing the absence. The
manager records this information in case it becomes significant information in a future
infection outbreak. Specimens may be requested to identify cause of illness or
infection, such as a stool sample in the case of symptoms of diarrhoea and vomiting.
Further guidance can be found on the following site - www.hse.gov.uk
6.2 Good hand washing techniques
Wearing of gloves and their proper disposal will be an important aspect of infection
control, but correct hand washing procedures play a major part in the battle against
infection. All health related organisations will have a hand washing policy in place.
The single most important and neglected aspect of the control of infection is attention to
the basic rule of frequent, and thorough, hand washing by all health care professionals.
Studies indicate that health workers have been observed to wash their hands 25% to
50% less than they should to ensure they adhere to the requirements of best practice.
This means that some workers may need to wash their hands twice as much as they
actually do.
Infection can occur as the health worker moves from one person to another or handles
different sites on the same individual (e.g. giving an injection after bed bathing).
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It is known, for example, that hand washing technique causes a significant reduction in
the carriage of pathogenic bacteria on the hands. This is easy to learn and can
significantly reduce the spread of infection in the health care environment.
The aim is to remove dirt, organic material and transient micro-organisms. Good hand
washing can reduce spread of infection through faecal-oral transmission, contact with
respiratory secretions (sneezing, coughing) and contact with saliva, urine, blood and all
other body fluids, and contact with inanimate objects (door handles).
How to wash hands
Duration of washing is important, not only for mechanical action but also to allow
microbial products sufficient contact time. Therefore, it is recommended that hands are
rubbed vigorously together for 10 -15 seconds, generating friction on all surfaces of the
hand and fingers.
It is vital that you are able to demonstrate to your line manager/tutor that you adhere to
good hand washing techniques.
6.3 Correct hand washing sequence
See Unit 06 - Health, Safety and Wellbeing, section 4.4 “The recommended method for Hand
Washing” for diagrams for the correct hand washing sequence.
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6.4 When and why hand washing should be carried out
The purpose is to reduce the risk of carrying infection on hands which could be a risk
to self or others.
Washing your hands using soap and water is the single most effective
measure in the prevention of infection.
When you wash your hands you must choose the correct method of hand washing by
considering:
What you have just done
What you are about to do.
There are three types of hand washing:
Routine hand washing using soap/detergent/alcohol gel
Disinfectant hand washing using antiseptic soap/alcohol gel
Aseptic hand washing using surgical hand scrub.
(N.B. Bar soap is not recommended for use in communal settings as bar soap can
harbour harmful bacteria.)
Gels are not necessarily a good substitute for thorough hand-washing.
Routine hand washing
Routine hand washing should be used:
After using the toilet
After handling laundry or waste
After handling any patient/individual
Before and after preparing, handling or eating food
Before and after giving medication
Before and after removing gloves
Before starting work or after leaving work area
After bed making
When hands become visibly soiled
After touching animals
After handling any equipment that may be soiled.
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Some of the situations detailed previously such as handling laundry, wastes, and soiled
equipment should be carried out using protective gloves.
Rubbing hands vigorously with soap and water causes mechanical friction pulling dirt
away from the skin and into a dirt/soap suspension which can then be rinsed under
clear running water.
Disinfectant hand washing
Disinfectant hand washing should be used:
Before carrying out aseptic procedures
Before and after caring for patients/service users in isolation
Before and after handling open wounds, urethral catheters and IV lines
After handling equipment contaminated with body fluids
Alcohol gel may be used as an alternative to the above if there is no access to
soap and water when hands aren’t visibly soiled.
Aseptic hand washing
Aseptic hand washing should be used:
Before appropriate invasive surgical procedures or urinary catheter insertion
Before wound dressing.
Surgical hand wash is a broad spectrum, fast acting, persistent and non-irritating
preparation containing anti-microbial ingredients designed to significantly reduce the
number of micro- organisms on intact skin.
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6.5 Types of products used for hand washing
There are many products available for hand washing, including antibacterial soaps and
hand gel (gels do not replace hand washing but can be used when soap and water are
not available and until hand washing takes place).
6.6 Care of the skin
Frequent hand washing may cause skin problems, especially if hands are not dried
properly or the skin is not moisturised with approved hand creams. This can lead to hands
becoming chapped; cut, grazed or open wounds developing. Allergies to hand washing
preparations and gloves sometimes occur and must always be reported.
Skin lesions
Any cuts or grazes must be adequately covered with a waterproof dressing. Further
advice must be sought from managers in cases of eczema, psoriasis or other skin lesions
and guidelines adhered to.
Conclusion
The information you have read within this unit should increase your knowledge and
understanding, which will benefit you, the individuals you care for, key people and others.
Now complete the assessment questions for this unit in the workbook section.