Standard Infection Control Precautions (SICPs), covered in this chapter are to be used by all staff, in all care settings, at
all times, for all patients1 whether infection is known to be present or not to ensure the safety of those being cared for, staff and visitors in the care environment. Show
The Hierarchy of Controls detailed in appendix 20 should also be considered in controlling exposures to occupational hazards which include infection risks. SICPs are the basic infection prevention and control measures necessary to reduce the risk of transmission of infectious agent from both recognised and unrecognised sources of infection. Sources of (potential) infection include blood and other body fluids secretions or excretions (excluding sweat), non-intact skin or mucous membranes, any equipment or items in the care environment that could have become contaminated and even the environment itself if not cleaned and maintained appropriately. The application of SICPs during care delivery is determined by an assessment of risk to and from individuals and includes the task, level of interaction and/or the anticipated level of exposure to blood and/or other body fluids. To be effective in protecting against infection risks, SICPs must be applied continuously by all staff. The application of SICPs during care delivery must take account of;
Doing so allows staff to safely apply each of the 10 SICPs by ensuring effective infection prevention and control is maintained. SICPs implementation monitoring must also be ongoing to demonstrate safe practices and commitment to patient, staff and visitor safety. Further information on using SICPs for Care at Home can be found on the NHS National Education Scotland (NES) website. 1The use of the word 'Persons' can be used instead of 'Patient' when using this document in non-healthcare settings. Last updated: 10 May 2022 1.1 Patient Placement/Assessment for infection riskPatients must be promptly assessed for infection risk on arrival at the care area (if possible, prior to accepting a patient from another care area) and should be continuously reviewed throughout their stay. This assessment should influence patient placement decisions in accordance with clinical/care need(s). Patients who may present a particular cross-infection risk should be isolated on arrival and appropriate clinical samples and screening undertaken as per national protocols to establish the causative pathogen. This includes but is not limited to patients:
For assessment of infection risk see Section 2: Transmission Based Precautions. Further information can be found in the patient placement literature review. 1.2 Hand HygieneHand hygiene is considered an important practice in reducing the transmission of infectious agents which cause HAIs.Hand washing sinks must only be used for hand hygiene and must not be used for the disposal of other liquids. (See Appendix 3 of Pseudomonas Guidance) Before performing hand hygiene:
Hand washing should be extended to the forearms if there has been exposure of forearms to blood and/or body fluids. *For health and safety reasons, Scottish Ambulance Service Special Operations Response Teams (SORT) in high risk situations require to wear a wristwatch. To perform hand hygiene: Alcohol Based Hand Rubs (ABHRs) must be available for staff as near to point of care as possible. Where this is not practical, personal ABHR dispensers should be used. Perform hand hygiene:
Some additional examples of hand hygiene moments include:
Download and print the 5 moments of hand hygiene poster. Wash hands with non-antimicrobial liquid soap and water if:
In all other circumstances use ABHRs for routine hand hygiene during care. Staff working in the community should carry a supply of Alcohol Based Hand Rub (ABHR) to enable them to perform hand hygiene at the appropriate times. Where staff are required to wash their hands in the service user’s own home they should do so for at least 20 seconds using any hand soap available. Staff should carry a supply of disposable paper towels for hand drying rather than using hand towels in the individual’s own home. Once hands have been thoroughly dried, ABHR should be used. The use of antimicrobial hand wipes is only permitted where there is no access to running water. Staff must perform hand hygiene using ABHR immediately after using the hand wipes and perform hand hygiene with soap and water at the first available opportunity. (The video above demonstrating Hand Washing and Drying Technique was produced by NHS Ayrshire and Arran) For how to:
Skin care:
Surgical Hand Antisepsis Surgical scrubbing/rubbing: (applies to persons undertaking surgical and some invasive procedures) Perform surgical scrubbing/rubbing before donning sterile theatre garments or at other times e.g. prior to insertion of central vascular access devices.
Hand Hygiene posters/leaflets can be found at Wash Your Hands of Them Resources. Information on the WHO World Hand Hygiene Day 2022 with the theme 'Unite for safety - clean your hands' is available. Further information can be found in the Hand Hygiene literature reviews:
1.3 Respiratory and Cough HygieneRespiratory and cough hygiene is designed to minimise the risk of cross-transmission of respiratory illness (pathogens):
Staff should promote respiratory and cough hygiene helping those (e.g. elderly, children) who need assistance with this e.g. providing patients with tissues, plastic bags for used tissues and hand hygiene facilities as necessary. Further information can be found in the cough etiquette/respiratory hygiene literature review. 1.4 Personal Protective EquipmentBefore undertaking any care task or procedure staff should assess any likely exposure to blood and/or body fluids and ensure PPE is worn that provides adequate protection against the risks associated with the procedure or task being undertaken.All PPE should be:
Reusable PPE items, e.g. non-disposable goggles/face shields/visors must have a decontamination schedule with responsibility assigned. Further information on best practice for PPE use for SICPs can be found in Appendix 16. Gloves must:
Double gloving is only recommended during some Exposure Prone Procedures (EPPs) e.g. orthopaedic and gynaecological operations or when attending major trauma incidents and when caring for a patient with a suspected or known High Consequence Infectious disease. Double gloving is not necessary at any other time. For appropriate glove use and selection see Appendix 5. Further information can be found in the Gloves literature review. Aprons must be:
Full body gowns/Fluid repellent coveralls must be:
The choice of apron or gown is based on a risk assessment and anticipated level of body fluid exposure. Routine sessional use of gowns/aprons is not permitted. Sterile surgical gowns must be:
Reusable gowns must:
If hand hygiene with soap and water is required, this should not be performed whilst wearing an apron/gown in line with a risk of apron/gown contamination; hand hygiene using ABHR is acceptable. Further information can be found in the Aprons/Gowns literature review. Eye/face protection must:
Regular corrective spectacles and safety spectacles are not considered eye protection. Further information can be found in the eye/face protection literature review. Fluid Resistant Type IIR surgical face masks must be:
Transparent face masksTransparent face masks may be used to aide communication with patients in some settings Transparent face masks must;
Further information can be found in:
During the ongoing COVID-19 pandemic please also refer to the Scottish Government Extended Use of Facemask Guidance. The extended use of facemask guidance is not considered an element of SICPs but an additional mitigation measure applied in response to the ongoing COVID-19 pandemic response. Footwear must be:
Further information can be found in the footwear literature review. Headwear must be:
Further information can be found in the headwear literature review For the recommended method of putting on and removing PPE see video below and Appendix 6. COVID-19 - the correct order for donning, doffing and disposal of PPE for HCWs in a primary care setting from NHS National Services Scotland on Vimeo. Sessional use of PPE Typically, sessional use of any PPE is not permitted within health and care settings at any time as it may be associated with transmission of infection within health and care settings. Due to the much wider and frequent use of FRSMs eye/face protection (where required) by HCWs during the ongoing COVID-19 pandemic and during periods of increased respiratory activity in health and care settings both as part of service user direct care delivery and extended use of facemasks guidance, sessional use of FRSMs and eye/face protection is permitted at this time. This means that FRSMs and eye/face protection (where required) can be used moving between service users and for a period of time where a HCW is undertaking duties in an environment where there is exposure to patients with suspected or confirmed respiratory infection. A session ends when the healthcare worker leaves the clinical setting or exposure environment. When using FRSMs and eye/face protection sessionally it is important to note the following;
The above measures in conjunction with safe donning and doffing of PPE ensure the safety of the HCW and the service user. No other PPE is permitted to be worn sessionally moving between service users or care tasks. This includes gloves, aprons and gowns. PPE for Visitors PPE may be offered to visitors to protect them from acquiring a transmissible infection. If a visitor declines to wear PPE when it is offered then this should be respected and the visit must not be refused. PPE use by visitors can not be enforced and there is no expectation that staff monitor PPE use amongst visitors. Below is the PPE which should be worn where it is appropriate to do so and when the visitor chooses to do so. Visitors do not routinely require PPE unless they are providing direct care to the individual they are visiting. In line with extended use of face mask guidance, visitors are strongly recommended to continue to wear a face covering when visiting a healthcare setting. Should they arrive without one, they can be provided with a FRSM. The table below provides a guide to PPE for use by visitors if delivering direct care.
*1 unless providing direct care which may expose the visitor to blood and/or body fluids i.e. toileting. *2 unless providing care resulting in direct contact with the service user, their environment or blood and/or body fluid exposure i.e. toileting, bed bath. *3 Unless providing direct care and splashing/spraying is anticipated 1.5 Safe Management of Care EquipmentCare equipment is easily contaminated with blood, other body fluids, secretions, excretions and infectious agents. Consequently it is easy to transfer infectious agents from communal care equipment during care delivery. Care equipment is classified as either:
Before using any sterile equipment check that:
Decontamination of reusable non-invasive care equipment must be undertaken:
Adhere to manufacturers’ guidance for use and decontamination of all care equipment. All reusable non-invasive care equipment must be rinsed and dried following decontamination then stored clean and dry. Decontamination protocols should include responsibility for; frequency of; and method of environmental decontamination. An equipment decontamination status certificate will be required if any item of equipment is being sent to a third party e.g for inspection, servicing or repair. Guidance may be required prior to procuring, trialling or lending any reusable non-invasive equipment. Further information can be found in the management of care equipment literature review. For how to decontaminate reusable non-invasive care equipment see Appendix 7. 1.6 Safe Management of Care EnvironmentIt is the responsibility of the person in charge to ensure that the care environment is safe for practice (this includes environmental cleanliness/maintenance). The person in charge must act if this is deficient.The care environment must be:
Staff groups should be aware of their environmental cleaning schedules and clear on their specific responsibilities. Cleaning protocols should include responsibility for; frequency of; and method of environmental decontamination. When an organisation adopts decontamination processes not recommended in the NIPCM the care organisation is responsible for governance of and completion of local risk assessment(s) to ensure safe systems of work Further information can be found in the routine cleaning of the environment in hospital setting literature review. 1.7 Safe Management of LinenClean linen
Linen used during patient transfer
For all used linen (previously known as soiled linen):
For all infectious linen (this mainly applies to healthcare linen) i.e. linen that has been used by a patient who is known or suspected to be infectious and/or linen that is contaminated with blood and/or other body fluids e.g. faeces:
Local guidance regarding management of linen may be available. All linen that is deemed unfit for re-use e.g torn or heavily contaminated, should be categorised at the point of use and returned to the laundry for disposal. Further information can be found in the safe management of linen literature review and National Guidance for Safe Management of Linen in NHSScotland Health and Care Environments - For laundry services/distribution. Further information about linen bagging and tagging can be found in Appendix 8. Scottish Government uniform, dress code and laundering policy is available. 1.9 Safe Disposal of Waste (including sharps)Scottish Health Technical Note (SHTN) 3: NHSScotland Waste Management Guidance contains the regulatory waste management guidance for NHSScotland including waste classification, segregation, storage, packaging, transport, treatment and disposal.The Health and Safety (Sharp Instruments in Healthcare) Regulations 2013 outline the regulatory requirements for employers and contractors in the healthcare sector in relation to the safe disposal of sharps. Categories of waste:
Waste Streams:
For care/residential homes waste disposal may differ from the categories described above and guidance from local contractors will apply. Refer to SEPA guidance. Safe waste disposal at care area level: Always dispose of waste:
Liquid waste e.g. blood must be rendered safe by adding a self-setting gel or compound before placing in an orange lidded leak-proof bin. Waste bags must be no more than 3/4 full or more than 4 kgs in weight; and use a ratchet tag/or tape (for healthcare waste bags only) using a ‘swan neck’ to close with the point of origin and date of closure clearly marked on the tape/tag. Store all waste in a designated, safe, lockable area whilst awaiting uplift. Uplift schedules must be acceptable to the care area and there should be no build-up of waste receptacles. Sharps boxes must:
Local guidance regarding management of waste at care level may be available. Further information can be found in the safe disposal of waste literature review. 1.10 Occupational Safety: Prevention and Exposure Management (including sharps)Exposure in relation to blood borne viruses (BBV) is the focus within this section and reflects the existing evidence base.The Health and Safety (Sharp Instruments in Healthcare) Regulations 2013 outline the regulatory requirements for employers and contractors in the healthcare sector in relation to:
Sharps handling must be assessed, kept to a minimum and eliminated if possible with the use of approved safety devices. Manufacturers’ instructions for safe use and disposal must be followed. Needles must not be re-sheathed/recapped.4 Always dispose of needles and syringes as 1 unit. If a safety device is being used safety mechanisms must be deployed before disposal. An occupational exposure is a percutaneous or mucocutaneous exposure to blood or other body fluids. Occupational exposure risk can be reduced via application of other SICPs and TBPs outlined within the NIPCM. A significant occupational exposure is a percutaneous or mucocutaneous exposure to blood or other body fluids from a source that is known, or found to be positive for a blood borne virus (BBV). Examples of significant occupational exposures would be:
There is a potential risk of transmission of a Blood Borne Virus (BBV) from a significant occupational exposure and staff must understand the actions they should take when a significant occupational exposure incident takes place. There is a legal requirement to report all sharps injuries and near misses to line managers/employers. Additionally, employers are obligated to minimise or eliminate workplace risks where it is reasonably practicable. Immunisation against BBV should be available to all qualifying staff, and testing (and post exposure prophylaxis when applicable) offered after significant occupational exposure incidents. For the management of an occupational exposure incident see Appendix 10 Exposure prone procedures (EEPs) are invasive procedures where there is a risk that injury to the healthcare worker may result in the exposure of the patient’s open tissues to the blood of the worker (bleed-back). There are some exclusions for HCWs with known BBV infection when undertaking EPPs. The details of these and further information can be found in the occupational exposure management (including sharps) literature review. 4 A local risk assessment is required if re-sheathing is undertaken using a safe technique for example anaesthetic administration in dentistry. Which action by the nurse may cause contamination of a sterile field quizlet?A sterile field becomes contaminated if the nurse turns his or her back to it. Any item that comes into contact with a sterile field must be sterile. Reaching over a sterile field contaminates the sterile field. Any items below waist level are considered contaminated.
Which action would the nurse perform to ensure preparation of a sterile field?While preparing a sterile field, a nurse opens the outermost flap by stretching his or her arm away from the sterile field.
Which action would the nurse avoid while opening a sterile item on a flat surface?Which action should the nurse avoid while opening a sterile item on a flat surface? The nurse should grasp only 2.5 cm (1 inch) of the border to maneuver the field on a table surface while opening a sterile item on a flat surface.
Which precautions should the nurse follow while performing surgical asepsis?Safety considerations:. Hand hygiene is a priority before any aseptic procedure.. When performing a procedure, ensure the patient understands how to prevent contamination of equipment and knows to refrain from sudden movements or touching, laughing, sneezing, or talking over the sterile field.. |