Key tips for infection prevention and control in general practice
What advice does the CQC offer on how you can avoid infection and stay in control of your general practice
CREDIT: This is an edited version of an article that originally appeared on CCQ
The CQC judges compliance with the registration requirements provided for by the regulations; all adult health and social service providers must meet or exceed the Code of practice on infection prevention and control and related advice. The code states:
“Good infection prevention (including cleanliness) is essential to ensure that people using health and social services receive safe and effective care. Effective infection prevention and control should be part of everyday practice and applied consistently by everyone. Good management and organizational processes are essential to ensure that high standards of infection prevention (including cleanliness) are developed and maintained”.
The CQC bases its expectations of registered suppliers on the criteria contained in the code. Their findings help them decide whether providers are providing safe, efficient, and well-managed services.
The 2021 National Healthcare Cleanliness Standards supersede 2007 specifications for NHS cleanliness. These guidelines reflect the expectations of general practitioners who are already covered by the regulations and the Code of practice – for example, IPC audit processes, waste management, cleaning schedules and equipment maintenance.
The infection prevention and control (IPC) guidelines reinforce existing messages and provide more clarity. This includes updates to care pathways to recognize testing and exposure. The guide also contains appendices. They support the remobilization and maintenance of mental health and learning disabilities services.
Providers should have an effective IPC policy that should be relevant to their practice. It should be accessible to all staff and regularly updated, and should include contact details for the local team of CIP specialists.
The policy should include specific requirements for high-risk procedures – for example, the fitting of contraceptive devices and minor surgery. There should be an IPC manager with overall responsibility for the IPC who should have the authority to direct and implement changes if necessary. There should be an IPC audit program, so that policies and procedures are effective and up to date. There should be evidence of the issues identified by the audit and how they were resolved.
The policy should include staff training requirements and frequency of training updates.
Cleaning contractors should have a general cleaning program which should include cleaning frequency for specific areas, fixtures and fittings including high frequency touch sensitive items such as keyboards, telephones, door handles and light switches. It must be checked regularly for compliance and conform to what the general public expects in healthcare establishments. The policy should include responsibilities for cleaning specific clinical equipment.
Staff must have access to occupational health services. They should be vaccinated according to Public Health England Green Book. The policy should include the use of personal protective equipment (PPE); this includes training staff in the safe use and disposal of PPE.
Curtains and blinds – the curtains surrounding the examination couches can be disposable or reusable. There is no mandatory frequency for changing or washing the curtains, although the NNational cleanliness specifications in the NHS suggests the frequency. The specifications are guidance on defining and measuring performance outcomes in primary care. The CQC expects suppliers to assess the risk associated with each item, including curtains; vendors must follow their own protocol.
There should be a schedule for cleaning curtains and other window coverings in non-clinical areas; this should include regular vacuuming. The schedule should specify when curtains will be cleaned and curtains should be changed immediately if visibly soiled or stained.
The rugs – clinical rooms should not have carpets. There should be a policy for the frequency of carpet cleaning in consulting rooms and other common areas. The policy should include what to do if mats become contaminated with body fluids or spills.
Medical waste – primary care providers have a legal duty of care which requires that all reasonable steps be taken to handle waste appropriately, from the point of generation to final disposal.
General clinical waste – waste receptacles should be easily accessible to staff at the point of use. In clinical areas, they should be fitted with a cover and operated with a foot pedal. Waste must be assessed and sorted appropriately. Garbage bags must be:
- maximum two-thirds full and securely tied;
- labeled with address and date before collection;
- stored in a secure, clean and designated area pending collection.
Medicine waste – medicine waste should be stored in a designated bin and collected regularly by an appropriate waste disposal company. Purple-top bins, including sharps bins, must be available. These are intended for the elimination of cytotoxic drugs (including hormones); staff should know which drugs should be thrown in each bin.
Denaturation kits should be available for disposal of controlled drugs. There should be a written procedure to govern the process, and evidence that CDs from dispensary stock are disposed of only in the presence of an authorized witness. Labels, prescriptions and other documents identifying the patient should be treated as confidential waste.
The sharps – sharp objects should be assessed and disposed of in the appropriate container. Containers have orange, yellow or purple lids depending on the nature of the item. Containers must be labeled during assembly and locking. They should not be filled above the black line. Lock and discard containers after three months, even if they are not full. All staff should be assessed for risk of contracting blood-borne viruses and should be offered vaccination, if appropriate. The process of action following a sharps injury should be clear and accessible to all staff.
Hand hygiene – adequate hand washing facilities should be available and easily accessible for all staff. This should allow for hand washing in hot water using the correct technique. Liquid soap, paper towels and hydroalcoholic gel must be available. Hand hygiene should be included in staff training. Disposable gloves and other PPE should be available and used as needed, with staff training provided as necessary.
The CQC uses these regulations when reviewing to assess whether a practice is:
- well conducted.
When the CQC inspects infection prevention and control management, it assesses against:
- Policy 12 (Safe Care and Treatment).
- Regulation 15 (Premises and equipment) of the Health and Welfare Act 2008 (Regulated Activities) Regulations 2014.
These regulations remind suppliers that they must:
Assess the risk and prevent, detect and control the spread of infections, including those associated with health care.
Ensure that healthcare premises are clean, secure, suitable and used correctly, and that a provider maintains hygiene standards appropriate to the purpose for which they are used.
The CQC also uses key lines of inquiry – in particular, S1 “Safeguarding and Protection against Abuse” which assesses how providers:
- maintain standards of cleanliness and hygiene;
- have reliable systems to prevent and protect people against nosocomial infection;
- maintain and use the facilities and premises in such a way as to ensure the safety of persons;
- manage waste and clinical specimens to ensure human safety.