Guidelines for infection prevention

A renewed focus on instrument decontamination and Healthcare-Associated Infections (HCAIs) followed the report by the Healthcare Commission in late 2008, which showed a fall in the percentage of organisations that meet core standards on decontamination of reusable medical devices. In 2007 84.8 per cent of organisations reached satisfactory standards of instrument decontamination – 2008 saw a 7 per cent drop to only 77.3 per cent. This is the lowest level in any of the three years that have been the subject to the annual healthcheck. Last year’s figure means that potentially almost 1 in 4 organisations have not reached the expected levels of cleanliness which comply with the Healthcare Commission’s standards.
    
The Association for Perioperative Practice is working with other groups on consultations designed to build public confidence in decontamination and infection control.

Publications
Over the years various documents have been published by the government – ‘Getting Ahead of the Curve’ (DH 2002); ‘Winning Ways: Working Together to Reduce Health Care Associated Infection in England’ (DH 2003); ‘Saving Lives: A Delivery Programme to Reduce Health Care Associated Infection’ (DH 2005); ‘Essential Steps to Safe, Clean Care: Reducing Health Care Associated Infection’ (DH 2006c) – in an effort to introduce preventative measures to reduce HCAIs.
    
The publication of the Health Act 2006 (DH 2006b), introducing the Code of Practice for the Prevention and Control of Health Care Associated Infections (DH 2006a), is to support the reduction of HCAIs but more importantly ensures that all NHS bodies are held to account for HCAIs.
    
The Code of Practice is intended to help NHS bodies plan and implement strategies to prevent and control infection and sets out criteria to ensure that patients are cared for in a clean environment. The code ensures that the risk of HCAIs is kept as low as possible.
    
The code defines an HCAI as: ‘Any infectious agent acquired as a consequence of a person’s treatment by the NHS or which is acquired by a Health Care Worker (HCW) in the course of their duties’ (DH 2006a, p1).
    
NHS bodies must ensure that when commissioning services from contractors they have appropriate systems to protect patients, staff and visitors as ‘far as reasonably practicable’ from HCAIs (DH 2006a).
    
The Code is presented under three headings and outlines systems within each that are required to be in place to ensure that evidence-based protocols comply with the provisions within the Act to protect patients, visitors and staff:

• Management, organisation and the environment
• Clinical Care Protocols
• Health Care Workers.

Under each heading are duties against which the trust (acute or other) will monitor its compliance. Each of the provisions of the basic code applies to all acute trusts in England and Wales. Other NHS bodies such as Primary Care Trusts, Ambulance or Mental Health Trusts may be exempt from some of the other provisions.

Key aspects
Duty 2 part d: The NHS body must ensure that all staff whose normal duties are directly or indirectly concerned with patient care receives suitable and sufficient training, information and supervision on the measures to enable them to carry out their duties taking all necessary measures to prevent and control risks of infection (DH 2006a).
    
Duty 4 parts b–f: The Code designates lead managers for decontamination and requires NHS bodies to ensure that there are effective arrangements for the decontamination of instruments and other equipment.
    
Duty 4 Part e: There is adequate provision of suitable handwashing facilities and anti-bacterial hand rubs (DH2006a).
    
Duty 4 part h: Clothing worn by staff when carrying out their duties is clean and fit for purpose (DH 2006a).
    
Duty 10: NHS bodies must have in place core clinical care protocols for the prevention and control of infection. These include:

• Standard (Universal) Precautions. This should form part of induction programmes, the policy based on evidence which includes hand hygiene and personal protective equipment and the policy audited for compliance.
• Aseptic technique. The technique should be standardised, clinical procedures should be  carried out in such a way that promotes and maintains the principles of asepsis.
• Safe handling and disposal of sharps. Protocols should include risk management and training in the management of needle-stick injuries and the provision of medical devices that incorporate sharps protection mechanisms.
• Prevention of occupational exposure to blood borne viruses (BBV) including prevention of sharps injuries.
• Disinfection policy.
• Control of infections with specific alert organisms such as MRSA and C. dif.   

The Code of Practice reinforces the crucial need among all healthcare workers, including perioperative practitioners, to adhere to policies and procedures aimed at the prevention and control of HCAIs. We all have a legal duty to promote our codes of conduct where we do the patient no harm. Review your own policies; be involved in revising them if necessary; take the lead in auditing them; and ensure that your own practice is compliant. As part of the annual heath check the Healthcare Commission will ensure that your organisation is fit for purpose.

Diane Gilmour is President-Elect of AfPP and is the Association’s Decontamination Lead.

About the AfPP
The Association for Perioperative Practice (AfPP) was established as the National Association of Theatre Nurses, known as NATN, in 1964. It is a registered charity working to enhance skills and knowledge within operating departments, associated areas and sterile services departments. It aims to enhance the quality of care in the NHS and the independent sector throughout the UK.

AfPP also works to encourage the exchange of professional information between members and co-operation with other professional bodies. These include the Departments of Health, the Perioperative Care Collaborative, the Nursing, Midwifery and Health Visiting Advisory Committee (Scotland), the medical Royal Colleges, CNOs of all four member countries, Skills for Health and many of the British Safety Institution Committees and other groups set up to discuss specific issues.