Infection Control

Author:	Jono Erodotou
Responsibility:	All Staff
Effective Date:	01 June 2024
Review Date:	30th May 2025
Approved By:
Version Number:	01

Amendment / Review History #

Date	Author	Comments

Purpose #

The purpose of this policy is to:

▸ To provide advice for staff to help minimise the risk of the spread of infection.
▸ To provide information and guidance on the management of some common communicable diseases.
▸ To provide the resources and support systems required to promote quality patient care and provide a safe environment for staff and patients.
▸ Ensure patients are cared for in an environment that is safe and clean, and where the risk of them acquiring an infection is as low as possible.

References #

▸ NHS England – National infection prevention and control manual (NIPCM)
▸ NHS England – Standard infection control precautions (SICPs) https://www.england.nhs.uk/national-infection-prevention-and-control-manual-nipcm-for-england/chapter1-standard-infection-control-precautions-sicps/ 󰏌
▸ APIC – Guide to Infection Prevention in Emergency Medical Services 2013
▸ Overview of HIQA Unannounced Infection Prevention and Control Inspection in 2015 – HIQA
▸ Gama Healthcare – Safety Data Sheet
▸ NICE Clinical Guideline – Healthcare-associated infections: prevention and control in primary and community care 2012
▸ NICE Clinical Guideline – Infection: Prevention and Control of Healthcare-Associated Infections in Primary and Community Care Update
▸ S.I. No. 135 of 2014 – Prevention of Sharps Injuries
▸ Health Information and Quality Authority (HIQA) – National Standards for the prevention and control of healthcare associated infections in acute healthcare services, 2017
▸ World Health Organisation (WHO) Hand hygiene

Responsibilities & Reporting #

Management Team
▸ Provide a safe environment for staff, patients and public.
▸ Implement continuing and training programs.
▸ Provide periodic audit.
▸ Counselling and management of staff in relation to Infection Control Incidents.
▸ Provide personal protective equipment for use by operational ambulance staff.
▸ Provide the necessary cleaning/disinfecting agents and equipment for infection control on ambulances and at company bases.
▸ Be conscious when purchasing new equipment for use on Ambulances of infection implications.

Each individual staff member
▸ Remain current with K4 Medical Services Policies and Procedures
▸ Follow infection control procedures and policies
▸ Educate patients and their families where appropriate.
▸ Be vigilant and report infection control threats to management.
▸ Be proactive in washing your hands and encourage your colleagues to do the same.

Training & Records #

Staff training for infection control will be run annually. On-going educational programmes regards infection control and updated information within this area will be highlighted to staff through Moodle for completion.
Records of attendance will be stored by management.

Purchasing decisions #

All decisions relating to infection control purchasing will be brought to the Management Team to ensure it is fit for purpose and fits the infection control policy and associated procedures.

Risk Assessments #

This policy will be assessed against, and used to inform, the company’s overall risk register. The risk assessment will consider the following, at a minimum:

▸ Cleaning Procedures
▸ Cleaning Materials & Equipment
▸ Cleaning and Disinfection of Infectious pathogens
▸ Process risk to patients
▸ Process risk to staff
▸ Process risk to other healthcare workers

This policy will be reviewed and updated as a result of identified risks.

Infection Control Precautions #

Standard Precautions
▸ Standard Precautions refers to the practice of wearing appropriate, medical articles such as gloves, goggles, gowns or face shields to prevent the exposure to potential pathogens. These precautions are ‘standard’ because they are pre-cautions that healthcare providers should take with every patient, every time.
▸ Precautions are observed to prevent contact with blood or other potentially infectious materials.
▸ Blood-borne pathogens such as Hepatitis A, Hepatitis B, and HIV are all infections that can be transferred from person to person through body fluids. Since healthcare providers may not know a patient’s infectious status, each person should be assumed to be potentially contagious, and standard precautions must be utilised.

Standard precautions include the management of:
Hand hygiene
Use of personal protective equipment (PPE)
Respiratory hygiene and cough etiquette
Appropriate patient placement
Safe injection practices
Management of sharps
Management of needle stick injuries/contamination incident
Decontamination of reusable medical equipment
Decontamination of the environment
Management of spillages of blood and body fluids
Management of laundry
Management of waste

 

Contact Precautions
Should be used for infections that can be transmitted by direct contact with the patient, e.g. Clostridium difficile, norovirus (winter vomiting bug). Patients who present with diarrhoea may have an infectious origin. When examining such patients Contact Precautions should be adhered to, to prevent you and your clothes, equipment getting contaminated.

▸ Wear a disposable plastic apron and gloves for all interactions that may involve direct contact with the patient.
▸ Wear gloves if there is a risk of exposure to blood, body fluids, secretions or excretions.
▸ Perform hand hygiene after patient contact/removal of gloves.

Droplet Precautions
Should be used for infections such as influenza and meningococcal meningitis which can be transmitted by droplets that are generated by the patient during coughing, sneezing, talking, or while performing cough inducing procedures, e.g., sputum induction, administration of aerosolised medications, airway suctioning and during treatment of lesions/abscesses when aerosolization of drainage fluid is anticipated.

▸ Wear a disposable plastic apron, gloves and surgical facemask for all interactions that may involve direct contact with the patient and within proximity (i.e. 3 feet/1 meter). In some instances, the patient may be required to wear the face mask.
▸ Wear gloves if there is a risk of exposure to blood, body fluids, secretions or excretions.
▸ Perform hand hygiene after patient contact/removal of gloves.
▸ Respirator masks (FFP2/3) masks maybe required for specific suspected or confirmed infections during aerosol generating procedures such as above procedures for influenza.

Airborne Precautions
Should be used for infections that can be transmitted by very small respiratory particles that remain suspended in the air e.g. infective pulmonary or laryngeal TB.

▸ Wear a disposable plastic apron, gloves and respirator mask (FFP2/3) for all interactions with the patient.
▸ Wear gloves if there is a risk of exposure to blood, body fluids, secretions or excretions
▸ Perform hand hygiene after patient contact/removal of gloves.
▸ Respirator masks (FFP2/3) are designed to filter the air before it is inhaled by the person wearing the mask. Correct wearing of the respirator mask is essential
▸ FFP3 masks are recommended for aerosol generating procedures for all patients with a suspected or confirmed airborne infection and for routine care of patients with Multi-drug resistant TB and extremely drug resistant TB.
▸ FFP3 masks are recommended for routine care of patients with known or suspected pulmonary or laryngeal TB where MDR-TB or XDR-TB is not suspected.
▸ If a patient who is suspected or known to have an infection that is transmitted through the airborne route is waiting in a communal area, they should be asked to wear a surgical mask as this will reduce the risk of transmission to others.

Hand Hygiene

▸ All vehicles are equipped with alcohol-based sanitising hand gel. It is vitally important that staff use this gel following the removal of gloves in situations whereby hand washing facilities are not readily available.
▸ When staff have completed assisting with the embarkation of patients, the loading of stretcher patients into the ambulance, they should remove their gloves, dispose of same as health care risk waste and apply hand gel before getting into drivers compartment of the ambulance.
▸ Hand washing must be carried out in the following way in accordance with HIQA and WHO;

Before and after every patient contact.
Before/after all care activities.
Before a procedure.
After a procedure even if gloves were worn.
Between different patients.
After removal of gloves.
Before preparing, handling or eating food.
After visiting the toilet.
Hand Hygiene audits are conducted on a yearly basis.

 

Gloves
▸ Gloves are not to be worn while driving a vehicle, either to or from an incident.
▸ Wearing gloves does not eliminate the need for hand hygiene.
▸ Procedures for hand washing (see hand hygiene appendix) must always be adhered to.

Personal Care #

The human body can provide places for disease-causing germs and parasites to grow and multiply. These places include the skin and in and around the openings to the body. It is less likely that germs and parasites will get inside the body if people have good personal hygiene habits. Good personal care & hygiene is always essential.

Uniforms
Each staff member has been issued with shirt and jacket.
▸ Uniforms must always be neat and clean.
▸ Soiled uniforms / Garments should be placed into an Alginate bag as soon as practical, and the individual should change into a clean uniform.

Personal Grooming
▸ Keep nails short, clean and cut smoothly.
▸ Nails must be kept clean, and free from dirt.
▸ Jewellery is restricted to a flat ring/wedding band.
▸ All hair must be neatly tied up and secured.
▸ Some healthcare facilities may be requiring staff to remove any objects below the elbow. In such instances staff will comply with local requirements.

Blood, Bodily fluids, Sharps & Needlestick Incidents #

For this policy, the definition of a sharp includes items such as needles, sharp-edged instruments, broken glassware, any other item that may be contaminated with blood or body fluids and may cause laceration or puncture wounds, such as razors, sharp tissues, spicules of bone and teeth.

Sharps & Needlestick Incidents
All actual sharps and needlestick incidents must be reported to Management immediately. Any ‘near miss’ events are to be reported before or at the end of the shift.

The company undertakes risk-assessment about sharps and needlestick incidents. The company will take measures to reduce the number of times sharps are used; and reduce the risk to staff, patients and public.

A sharps injury is any breaking or damage to skin due to sharps & needle stick incident.

Sharps Injury Procedure;

▸ Encourage bleeding from the wound

▸ Wash the wound in running water, do not scrub

▸ Cover the wound with a dressing

▸ Skin, eyes, mouth; wash with plenty of water

▸ Ensure the sharp is disposed of safely

▸ Report incident immediately to control.

▸ Complete an incident report form as per local policy

▸ The injured person should attend either the occupational health service or the closest ED department for prompt risk assessment. Urgent treatment may be required for high risk injures (PEP).

Exposure to Blood and Bodily Fluids
If exposure to blood or body fluids through sharps refer to sharps injury procedure.
All actual exposure/contact with blood or other bodily fluids must be reported to control immediately.

After a splash of blood or body fluids onto unbroken skin
▸ Wash the area immediately with running water.
▸ If running water is not available, clean the area with a gel or hand-cleaning solution.

After exposure of the eye
▸ Irrigate exposed eye immediately with water or normal saline.
▸ Sit in a chair, tilt the head back and ask a person to gently pour water or normal saline over the eye, gently pulling the eyelids up and down to make sure the eye is cleaned thoroughly.
▸ If wearing contact lenses, leave them in place while irrigating, as they form a barrier over the eye and will help protect it. Once the eye has been cleaned, remove the contact lenses and clean them in the normal manner. This will render them safe to wear again.
▸ Do not use soap or disinfectant on the eye.

After exposure of the mouth
▸ Spit the fluid out immediately.
▸ Rinse the mouth thoroughly, using water or normal saline, and spit out again.
▸ Repeat this process several times.
▸ Do not use soap or disinfectant in the mouth.
▸ In all cases, a health care worker should be contacted immediately.

 

Sharps & Sharps Waste #

▸ Always wear protective equipment during clinical procedures.
▸ Ask for assistance when taking blood / giving injections to uncooperative or confused patients.
▸ Sharps containers should be available at the point of use.
▸ Sharps such as small quantities of broken glass, drug vials, used needles, razors, blades etc. must be carefully disposed of in approved sharps containers.
▸ Discard sharps at the point of use into a sharp’s container and immediately the following use.
▸ Discard disposable syringes and needles wherever possible as a single unit, into sharps containers.
▸ Do not re-sheath or bend needles.
▸ Sharps containers are not to be filled above the fill line. Replace when ¾ full.
▸ Ensure Sharp containers are located/positioned / stored appropriately off the floor
▸ Never dispose of sharps in containers used for storage of other wastes, or place used sharps containers in clinical waste bags.
▸ Never attempt to decant contents of small sharps containers into larger containers
▸ The person locking the sharps container must tag the Sharps container.
▸ Sharps containers are located/stored safely, away from the public and out of reach of children.
▸ When full, sharps containers should be closed, sealed, tagged and placed in the designated receptacle in the base where they will be collected by a licensed healthcare waste collection service.
▸ Sharp containers awaiting removal by a contractor are to be stored in a secure, protected area
▸ All sharps containers must be disposed of into yellow wheelie containers.

Blood Spills / Bodily Fluids #

Spills of blood and other high-risk body fluids represent an infection risk and should be removed as soon as possible as described below. Body fluids/tissue that should be handled with the same precautions as blood includes:

▸ Body fluid containing visible blood.
▸ Vaginal secretions, semen, synovial fluid, cerebrospinal, peritoneal, pleural, pericardial, synovial, and amniotic fluids.
▸ Saliva in association with dentistry.
▸ Unfixed tissues and organs.

Precautions to be Taken with all Blood Spills
▸ Position a warning sign “cleaning in progress” beside the contaminated area.
▸ Keep other persons away from the contamination until it is effectively and appropriately dealt with.
▸ Cuts/abrasions or breaks in the skin must be covered with waterproof dressing.
▸ All necessary equipment to deal with a spillage must first be gathered, including personal protective equipment (PPE) and spill wipes.
▸ Consider which PPE is required. Single-use, non-sterile disposable gloves and a plastic apron must be worn when dealing with a spillage. If there is the potential for a splash to the conjunctiva or mucous membranes, face protection such as a mask and visor or goggles must be worn.
▸ Glass fragments must be picked up using a scoop and placed in a sharps bin.
▸ Eye protection must be worn when dealing with glass fragments.

Spots/Splashes of Blood or Small Volume Spills of Blood (less than 30mls)
▸ Wear a disposable plastic apron and gloves.
▸ Wipe up the spots/splashes/small volume
▸ Place waste into a yellow healthcare risk waste bag.
▸ Clean the area with a solution of detergent and warm water.
▸ Disinfect with disinfectant supplied (Wipes or Liquid spray)
▸ Remove gloves and apron and place into a yellow healthcare risk waste bag
▸ Perform hand hygiene
▸ Please refer to K4 Medical Services IPC Manuel list of acceptable cleaning equipment.

Large Volume Spill of Blood (greater than 30 mls)
▸ Wear a disposable plastic apron and gloves.
▸ If there is a risk of splashing, wear a mask and eye protection.
▸ Use of Spill wipes required. (follow instructions for use)
▸ Clean the area with a solution of detergent and warm water.
▸ Remove personal protective equipment and place in yellow healthcare risk waste bag.
▸ Perform hand hygiene immediately after removing gloves.
▸ Please refer to K4 Medical Services IPC Manuel list of acceptable cleaning equipment.

Spillage of Urine Faeces or Vomit
▸ Wear a disposable plastic apron and gloves.
▸ Chlorine-based disinfectants should not be added to spillages of urine or vomit as it may result in the release of toxic chlorine vapour.
▸ Cover the spill (urine, faeces or vomit) with disposable paper towels and allow being completely absorbed.
▸ Using the paper towels, mop up the area of spillage.
▸ Place the paper towels into a non-risk healthcare waste bag. If urine is blood-stained or faeces is from a patient known or suspected to have a gastrointestinal infection, then place the paper towels into a yellow healthcare risk waste bag.
▸ Clean the area with a solution of neutral detergent and warm water. Allow to dry.
▸ Then disinfect the contaminated area using a disposable cloth(wipes).
▸ Remove personal protective equipment and place in a non-risk healthcare waste bag.
▸ Perform hand hygiene immediately after removing gloves.

Waste #

Clinical Waste
▸ Clinical waste will be stored in a designated area clearly marked.
▸ Clinical waste management will be recorded and filed for traceability.
▸ When handling waste standard PPE must be used.
▸ Clinical waste is removed by ????? as required. (Licensed contractor)
▸ Clinical waste will be segregated
▸ Clinical waste must only be placed in containers suitable for the waste type.

Domestic Waste
The company has both general waste bins available, with a licensed contractor.

Management of Laundry
▸ Disposable linen will be used as standard.
▸ Linen will be utilised throughout the service. Sheets, pillowcases and duvet covers should change between each patient.
▸ Linen is stored in cabinet onboard ambulance to prevent/avoid contamination from surface contact or airborne deposition.
▸ Linen must be left with the patient at the drop-off point and exchanged for clean linen at hospital.
▸ Soiled lined must be placed in Red Alginate Bags for Laundry. If the soiled items are belonging to a patient, they must be handed over to receiving hospital.
▸ Solid linen must also be dealt with in the same manner and placed in sluice in receiving hospital.
▸ Infection control policy should be followed for the disposal of linen.

Cleaning & Disinfection #

Equipment
There are procedures on the use, cleaning, storage and care of cleaning equipment
▸ Cleaning materials supplied by Clear Trace, SD50 & SD25.
▸ Cleaning materials must be stored in the correct designated area.
▸ Cleaning materials should be separated accordingly by colour code and placed in separate areas to avoid cross-contamination.
▸ Under no circumstances should cleaning equipment designated for ambulance cleaning be used for any other purpose, e.g. toilets, kitchen area etc.
▸ Cleaning products supplied for designated areas may only be used in that specific area. E.g. Ambulance cleaning products are for use on the ambulance only.
▸ Domestic cleaning products are only for use for domestic purposes only, e.g. bathrooms, kitchens, floors etc.
▸ Where possible cleaning products will be single use. If not single use they will be changed regularly.
▸ Ambulance Cleaning Products will carry a yellow colour and or label.

Procedures / Decontamination
Decontamination: In healthcare settings, there are three levels of decontamination.

Cleaning
A process which removes soil, e.g. dust, dirt and organic matter, along with a large proportion of any microorganisms which may be present including bacterial spores. Micro-organisms cannot multiply on a clean, dry surface and many, e.g. coliforms, rapidly die. Cleaning must be undertaken before disinfection and sterilisation.

Disinfection
A process which destroys micro-organisms. The microbial activity of different disinfectants vary greatly, and few are capable of destroying highly resistant bacterial spores. Disinfection does not necessarily kill all (disregarding bacterial spores) micro-organisms present but reduces them to a level not harmful to health.

Sterilisation
A process which removes or destroys all micro-organisms. This process is generally used in the Hospital setting for sterilisation of surgical instruments, used for invasive procedures. Equipment used onboard the Ambulance that are for invasive procedures.

Schedules
As per appendices
Storage

▸ All cleaning equipment and supplies are stored at the base in specific areas.
▸ Any items placed in storage must be in their specified designated area for that item’s category.
▸ Health care risk waste returned to the base must be stored in healthcare risk waste receptacles in the designated area.
▸ There is a safe and minimal handling approach with healthcare risk waste; staff must ensure that the outside of sacks/containers is not contaminated.

Office / Base Cleaning
External cleaning company employed 2 hours per week. More available as required.

Vehicle Cleaning & Records
▸ All records of vehicle cleaning will be stored/maintained by control.
▸ The vehicle will be cleaned prior to, an upon return of, a deployment.
▸ The vehicle will be maintained in a clean state and will always be ready to be deployed.
▸ Please refer to K4 Medical Services IPC Manuel list of acceptable cleaning equipment.

Reusable medical devices
▸ Reusable medical devices will be subject to the same cleaning regime as vehicles.
Please refer to K4 Medical Services Services IPC Manuel list of acceptable cleaning equipment.

Vehicle Deep Clean
Vehicles will be deep cleaned as per the cleaning schedule and carried out as per the cleaning checklist.

Vehicle Hygiene Audit
Vehicle hygiene audits are carried out on a regular basis with issues identified and rectified through the process.

Recommended Staff Immunisations #

Hepatitis B
▸ Staff should be offered Hepatitis B vaccination if not previously vaccinated.
▸ Staff should have anti-HBs levels checked if previously vaccinated against Hepatitis B and response not known

BCG (Bacilus Calmette Guerin)
▸ Staff should have pre-employment base line Mantoux tuberculin testing performed if there is no BCG scar present, or no documented evidence of having received BCG vaccination.
▸ If there is an inadequate Mantoux response (defined as skin induration less than 5mm in diameter) then the staff member should be referred to their public
▸ health clinic or occupational health department, where BCG should be offered.
▸ Any staff member who has been in close contact with a case of smear-positive tuberculosis should be assessed by an occupational health department.

Varicella
▸ Staff without a definite history of chickenpox, proof of immunity or vaccination status, should be routinely screened for VZV IgG.
▸ In addition HCWs from outside Ireland and Western Europe are less likely to be immune. Vaccination should be offered to all non immune staff.
▸ Post-vaccination serological testing is not recommended. Where exposure occurs in a susceptible member of staff, advice should be sought Influenza
▸ Staff members should be offered vaccination against influenza on an annual basis each autumn.

Measles, Mumps, Rubella

▸ Health-care workers should have serological proof of immunity or evidence of having received two doses of MMR. Those who are non-immune should receive two doses of MMR. Post-vaccination testing is not recommended.
▸ Where exposure occurs in a susceptible staff member, advice should be sought from Occupational Health on further management and possible exclusion from the workplace.

Hand Hygiene Appendix #

▸ Cleaning hands with Water https://www.england.nhs.uk/wp-content/uploads/2022/09/nipc-manual-appendix-1-handwashing.pdf 󰏌

▸ Cleaning hands with hand rub https://www.england.nhs.uk/wp-content/uploads/2022/09/nipc-manual-appendix-2-handrubbing.pdf 󰏌

K4 Medical Services IPC Manuel #

To follow