NIPCM

Responsibilities for the content of this manual

HPS must ensure

• that the content of this manual remains evidence based.

Responsibilities for the adoption and implementation of this manual

Organisations must ensure:

• the adoption and implementation of this manual in accordance with their existing local governance processes
• systems and resources are in place to facilitate implementation and compliance monitoring of infection prevention and control as specified in this manual in all care areas
  • compliance monitoring includes all staff (permanent, agency and where required external contractors)
• there is an organisational culture which promotes incident reporting and focuses on improving systemic failures that encourage safe working practices including near misses

Managers of all services must ensure that staff:

• are aware of and have access to this manual
• have had instruction/education on infection prevention and control through attendance at events and/or completion of training (for example via NHS Education for Scotland (NES) and/or local board or organisation)
• have adequate support and resources available to enable them to implement, monitor and take corrective action to ensure compliance with this manual if this cannot be implemented a robust risk assessment must be undertaken and approved through local governance procedures
• with health concerns (including pregnancy) or who have had an occupational exposure are timeously referred to the relevant agency, for example General Practitioner, Occupational Health or if required Accident and Emergency
• have undergone the required health checks or clearance (including those undertaking Exposure Prone Procedures (EPPs)
• include infection prevention and control as an objective in their Personal Development Plans (or equivalent)

Staff providing care must ensure that they:

• understand and apply the principles of infection prevention and control set out in this manual
• maintain competence, skills and knowledge in infection prevention and control through attendance at education events and/or completion of training, for example NHS Education for Scotland (NES) and/or local board or organisation
• communicate the infection prevention and control practices to be taken by colleagues, those being cared for, relatives and visitors without breaching confidentiality
• have up to date occupational immunisations/health checks/clearance requirements as appropriate
• report to line managers and document any deficits in knowledge, resources, equipment and facilities or incidents that may result in transmission of infection including near misses e.g sharps or PPE failures
• do not provide care while at risk of potentially transmitting infectious agents to others - if in any doubt they must consult with their line manager, Occupational Health Department, Infection Prevention and Control Team (IPCT) or Health Protection Team (HPT)
• contact HPT/IPCT if there is a suspected or actual HAI incident/outbreak

Infection Prevention and Control Teams (IPCTs) and Health Protection Teams (HPTs) must:

• engage with staff to develop systems and processes that lead to sustainable and reliable improvements in relation to the application of infection prevention and control practices
• provide expert advice on the application of infection prevention and control in all care settings and on individual risk assessments as required including the HIIAT/HIIORT ensuring actions are taken following completion of HIIAT
• have epidemiological or surveillance systems capable of distinguishing patient case or cases requiring investigations and control
• complete documentation when an incident/outbreak or data exceedence is reported

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.

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 and any equipment or items in the care environment that could have become contaminated.

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 used continuously by all staff. SICPs implementation monitoring must also be ongoing to ensure compliance with safe practices and to demonstrate ongoing 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.

1.1 Patient Placement/Assessment for infection risk

Patients 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 placement decisions in accordance with clinical/care need(s).

Patients who may present a cross-infection risk include those:

• With diarrhoea, vomiting, an unexplained rash, fever or respiratory symptoms.
• Known to have been previously positive with a Multi-drug Resistant Organism (MDRO) e.g MRSA, CPE.
• Who have been hospitalised outside Scotland in the last 12 months.

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 Hygiene

Hand 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:

• expose forearms (bare below the elbows);
• remove all hand/wrist jewellery* (a single, plain metal finger ring or ring dosimeter (radiation ring) is permitted but should be removed (or moved up) during hand hygiene); bracelets or bangles such as the Kara which are worn for religious reasons should be able to be pushed higher up the arm and secured in place);
• ensure finger nails are clean, short and that artificial nails or nail products are not worn; and
• cover all cuts or abrasions with a waterproof dressing.

 *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:

1. before touching a patient;
2. before clean/aseptic procedures. If ABHR cannot be used then antimicrobial liquid soap should be used;
3. after body fluid exposure risk;
4. after touching a patient; and
5. after touching a patient’s immediate surroundings

 

Some additional examples of hand hygiene moments include:

• Before handling medication
• Before preparing food
• After visiting the toilet
• After removing PPE
• Between carrying out different care activities on the same patient

Download and print the 5 moments of hand hygiene poster.

Download and print the 4 moments poster for residential and care home settings.

Wash hands with non-antimicrobial liquid soap and water if:

• hands are visibly soiled or dirty;
• caring for patients with vomiting or diarrhoeal illnesses; or
• caring for a patient with a suspected or known gastro-intestinal infection e.g. norovirus or a spore forming organism such as Clostridioides difficile.

In all other circumstances use ABHRs for routine hand hygiene during care.

(The video above demonstrating Hand Washing and Drying Technique was produced by NHS Ayrshire and Arran)

Where there is no running water available or hand hygiene facilities are lacking, staff may use hand wipes followed by ABHR and should wash their hands at the first available opportunity.

For how to:

• wash hands see Appendix 1
• hand rub see Appendix 2

Skin care:

• Warm/tepid water should be used to reduce the risk of dermatitis; hot water should be avoided.
• Pat hands dry thoroughly after hand washing using disposable paper towels; avoid rubbing which may lead to skin irritation/damage.
• Use an emollient hand cream during work and when off duty.
• Do not use refillable dispensers or provide communal tubs of hand cream in the care setting.
• Staff with skin problems should seek advice from Occupational Health or their GP.

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.

• Remove all hand/wrist jewellery.
• Nail brushes should not be used for surgical hand antisepsis.
• Nail picks (single-use) can be used if nails are visibly dirty.
• Soft, non-abrasive, sterile (single-use) sponges may be used to apply antimicrobial liquid soap to the skin if licensed for this purpose.
• Use an antimicrobial liquid soap licensed for surgical scrubbing or an ABHR licensed for surgical rubbing (as specified on the product label).
• ABHR can be used between surgical procedures if licensed for this use or between glove changes if hands are not visibly soiled.
  
  
• For surgical scrubbing technique see Appendix 3.
• For surgical rubbing technique see Appendix 4. 

Hand Hygiene posters/leaflets can be found at Wash Your Hands of Them Resources.

Further information can be found in the Hand Hygiene literature reviews:

• Hand washing, hand rubbing and indications for hand hygiene
• Hand hygiene products
• Skin care
• Surgical hand antisepsis in the clinical setting

  (The video above demonstrating Surgical Scrubbing using ABHR was produced by Golden Jubilee National Hospital)

1.3 Respiratory and Cough Hygiene

Respiratory and cough hygiene is designed to minimise the risk of cross-transmission of respiratory illness (pathogens):

• Cover the nose and mouth with a disposable tissue when sneezing, coughing, wiping and blowing the nose.
• Dispose of all used tissues promptly into a waste bin.
• Wash hands with non-antimicrobial liquid soap and warm water after coughing, sneezing, using tissues, or after contact with respiratory secretions or objects contaminated by these secretions.
• Where there is no running water available or hand hygiene facilities are lacking, staff may use hand wipes followed by ABHR and should wash their hands at the first available opportunity.
• Keep contaminated hands away from the eyes nose and mouth.

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 Equipment

Before undertaking any procedure staff should assess any likely exposure and ensure PPE is worn that provides adequate protection against the risks associated with the procedure or task being undertaken.

All PPE should be:

• located close to the point of use;
• stored to prevent contamination in a clean/dry area until required for use (expiry dates must be adhered to);
• single-use only items unless specified by the manufacturer;
• changed immediately after each patient and/or following completion of a procedure or task; and
• disposed of after use into the correct waste stream i.e. healthcare waste or domestic waste.

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 be:

• worn when exposure to blood and/or other body fluids is anticipated/likely;²
• changed immediately after each patient and/or following completion of a procedure or task;
• changed if a perforation or puncture is suspected;
• appropriate for use, fit for purpose and well-fitting.

Double gloving is recommended during some Exposure Prone Procedures (EPPs) e.g. orthopaedic and gynaecological operations or when attending major trauma incidents.

For appropriate glove use and selection see Appendix 5.

Further information can be found in the Gloves literature review.

Aprons must be:

• worn to protect uniform or clothes when contamination is anticipated/likely e.g. when in direct care contact with a patient; and
• changed between patients and/or following completion of a procedure or task.

Full body gowns/Fluid repellent coveralls must be:

• worn when there is a risk of extensive splashing of blood and/or other body fluids e.g. in the operating theatre;
• worn when a disposable apron provides inadequate cover for the procedure/task being performed;
• changed between patients and immediately after completion of a procedure or task.

Further information can be found in the Aprons/Gowns literature review.

Eye/face protection (including full face visors) must:

• be worn if blood and/or body fluid contamination to the eyes/face is anticipated/likely e.g. by members of the surgical theatre team and always during Aerosol Generating Procedures. Regular corrective spectacles are not considered eye protection.
• not be impeded by accessories such as piercings/false eyelashes.
• not be touched when worn.

Further information can be found in the eye/face protection literature review.

Fluid Resistant Type IIR surgical face masks must be:

• worn if splashing or spraying of blood, body fluids, secretions or excretions onto the respiratory mucosa (nose and mouth) is anticipated/likely;
  • a full face visor may be used as an alternative to fluid resistant Type IIR surgical face masks to protect against splash or spray.  However, a full face visor alone is not sufficient when droplet precautions are being employed and a fluid resistant Type IIR surgical face mask and eye/face protection must be worn as outlined in Appendix 16.
• worn to protect patients from the operator as a source of infection e.g. when performing an epidural or inserting a Central Vascular Catheter (CVC);
• well fitting and fit for purpose (fully covering the mouth and nose) (manufacturers’ instructions must be adhered to ensure effective fit/protection); and
• removed or changed;
  • at the end of a procedure/task;
  • if the integrity of the mask is breached, e.g. from moisture build-up after extended use or from gross contamination with blood or body fluids; and
  • in accordance with specific manufacturers’ instructions.

Further information can be found in:

• aerosol generating procedures literature review
• surgical face masks literature review
• section 2.4 of the NIPCM
• appendix 11 of the NIPCM

Footwear must be:

• able to either withstand machine washing at 40°C or disinfection with a chlorine releasing agent. 
• non-slip, clean and well maintained, and support and cover the entire foot to avoid contamination with blood or other body fluids or potential injury from sharps; and
• removed before leaving a care area where dedicated footwear is used e.g. theatre, in these areas have a decontamination schedule with responsibility assigned.

Further information can be found in the footwear literature review.

Headwear must be:

• worn in theatre settings/clean rooms e.g. Central Decontamination Unit (CDU);
• well fitting and completely cover the hair; and
• changed/disposed of between clinical procedures/tasks or if contaminated with blood and/or body fluids;
• removed before leaving the theatre/clean room.

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.

If you are experiencing issues accessing the above video via YouTube please try the alternative version that can be accessed on Vimeo.

²Scottish National Blood Transfusion Service (SNBTS) adopt practices that differ from those stated in the National Infection Prevention and Control Manual.

1.5 Safe Management of Care Equipment

Care 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:

• Single-use – equipment which is used once on a single patient and then discarded. Must never be reused even on the same patient. The packaging carries the symbol below.
  • Needles and syringes are single use devices. They should never be used for more than one patient or reused to draw up additional medication.
  • Never administer medications from a single-dose vial or intravenous (IV) bag to multiple patients.
• Single patient use – equipment which can be reused on the same patient.
• Reusable invasive equipment - used once then decontaminated e.g. surgical instruments.
• Reusable non-invasive equipment (often referred to as communal equipment) - reused on more than one patient following decontamination between each use e.g. commode, patient transfer trolley.

Before using any sterile equipment check that:

• the packaging is intact
• there are no obvious signs of packaging contamination
• the expiry date remains valid

Decontamination of reusable non-invasive care equipment must be undertaken:

• between each use
• after blood and/or body fluid contamination
• at regular predefined intervals as part of an equipment cleaning protocol
• before inspection, servicing or repair

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 Environment

It 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:

• visibly clean, free from non-essential items and equipment to facilitate effective cleaning
• well maintained and in a good state of repair
• routinely cleaned in accordance with the Health Facilities Scotland (HFS) National Cleaning Specification:
  • A fresh solution of general purpose neutral detergent in warm water is recommended for routine cleaning. This should be changed when dirty or at 15 minutes intervals or when changing tasks.
  • Routine disinfection of the environment is not recommended. However, 1,000ppm available chlorine should be used routinely on sanitary fittings.

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.

Further information can be found in the routine cleaning of the environment in hospital setting literature review.

1.7 Safe Management of Linen

Clean linen

• Should be stored in a clean, designated area, preferably an enclosed cupboard.
• If clean linen is not stored in a cupboard then the trolley used for storage must be designated for this purpose and completely covered with an impervious covering that is able to withstand decontamination.

Linen used during patient transfer

• Any linen used during patient transfer e.g. blankets, should be categorised at the point of destination.

For all used linen (previously known as soiled linen):

• Ensure a laundry receptacle is available as close as possible to the point of use for immediate linen deposit.
• Do not:
  • rinse, shake or sort linen on removal from beds/trolleys;
  • place used linen on the floor or any other surfaces e.g. a locker/table top;
  • re-handle used linen once bagged;
  • overfill laundry receptacles; or
  • place inappropriate items in the laundry receptacle e.g. used equipment/needles.

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:

• Place directly into a water-soluble/alginate bag and secure; then place into a plastic bag e.g. clear bag and secure before placing in a laundry receptacle. This applies also to any item(s) heavily soiled and unlikely to be fit for reuse.
• Used and infectious linen bags/receptacles must be tagged e.g. ward/care area and date.
• Store all used/infectious linen 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 linen receptacles.

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.

1.8 Safe Management of Blood and Body Fluid Spillages

Spillages of blood and other body fluids may transmit blood borne viruses.

Spillages must be decontaminated immediately by staff trained to undertake this safely.

Responsibilities for the decontamination of blood and body fluid spillages should be clear within each area/care setting.

If superabsorbent polymer gel granules for containment of bodily waste are used these should be used in line with national guidance. In Scotland refer to http://www.hfs.scot.nhs.uk/publications/1575969155-SAN(SC)1903.pdf.  In England refer to https://www.cas.mhra.gov.uk/ViewandAcknowledgment/ViewAlert.aspx?AlertID=102937.

For management of blood and body fluid spillages see Appendix 9.

Further information can be found in the management of blood and body fluid in health and social care settings literature review.

 

 

 

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:

• Healthcare (including clinical) waste – is produced as a direct result of healthcare activities e.g. soiled dressings, sharps.
• Special (or hazardous) waste – arises from the delivery of healthcare in both clinical and non-clinical settings. Special waste includes a range of controlled wastes, defined by legislation, which contain dangerous or hazardous substances e.g. chemicals, pharmaceuticals.
• Domestic waste – must be segregated at source into:
  • Dry recyclates (glass, paper and plastics, metals, cardboard).
  • Residual waste (any other domestic waste that cannot be recycled).

Waste Streams:

• Black – Trivial risk:
  • Domestic waste or yellow and black stripes (small quantities of hygiene waste).
  • Final disposal to Landfill.
  • Clear/opaque receptacles may also be used for domestic waste at care area level.
• Orange, Light Blue (laboratory) – Low risk³
  • Orange - consists of items which are contaminated or likely to be contaminated with blood and/or body fluids. Final disposal following heat disinfection is to landfill.
  • Light Blue – laboratory/microbiological waste that must be autoclaved before disposal via the orange stream.

• Yellow– High risk:
  • Waste which poses ethical, highly infectious or contamination risks.
  • This includes anatomical and human tissue which is recognisable as body parts, medical devices and sharps waste boxes that have red, purple or blue lids.
  • Disposal is by specialist incineration.

• Red – Special waste
  • Chemical waste.

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:

• immediately and as close to the point of use as possible; and
• into the correct segregated colour coded UN 3291 approved waste bag (either orange/yellow for healthcare waste or black/clear/opaque for domestic) or container (sharps box).

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:

• have a dedicated handle;
• have a temporary closure mechanism, which must be employed when the box is not in use;
• be disposed of when the manufacturers’ fill line is reached; and
• be labelled with point of origin and date of closure.

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.

³Not required for boards with an on-site incinerator facility.  This applies only to NHS Borders.

1.10 Occupational Safety: Prevention and Exposure Management (including sharps)

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:

• arrangements for the safe use and disposal of sharps
• provision of information and training to employees
• investigations and actions required in response to work related sharps injuries

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.

A significant occupational exposure is:

• a percutaneous injury e.g. injuries from needles, instruments, bone fragments, or bites which break the skin; and/or
• exposure of broken skin (abrasions, cuts, eczema, etc); and/or
• exposure of mucous membranes including the eye from splashing of blood or other high risk body fluids.

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.  

For the management of an occupational exposure incident see Appendix 10

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.

SICPs may be insufficient to prevent cross transmission of specific infectious agents. Therefore additional precautions TBPs are required to be used by staff when caring for patients with a known or suspected infection or colonisation.

Clinical judgement and decisions should be made by staff on the necessary precautions.  This must be based on the:

• suspected or known infectious agent
• severity of the illness caused
• transmission route of the infectious agent
• care setting and procedures undertaken

TBPs are categorised by the route of transmission of infectious agents (some infectious agents can be transmitted by more than one route): Appendix 11 provides details of the type of precautions, optimal patient placement, isolation requirements and respiratory precautions required.  Application of TBPs may differ depending on the setting and the known or suspected infectious agent.

Contact precautions

Used to prevent and control infections that spread via direct contact with the patient or indirectly from the patient’s immediate care environment (including care equipment). This is the most common route of cross-infection transmission.

Droplet precautions

Used to prevent and control infections spread over short distances (at least 3 feet or 1 metre) via droplets (greater than 5μm) from the respiratory tract of one individual directly onto a mucosal surface or conjunctivae of another individual. Droplets penetrate the respiratory system to above the alveolar level.

Airborne precautions

Used to prevent and control infections spread without necessarily having close patient contact via aerosols (less than or equal to 5μm) from the respiratory tract of one individual directly onto a mucosal surface or conjunctivae of another individual. Aerosols penetrate the respiratory system to the alveolar level.

Further information on Transmission Based Precautions can be found in the definitions of Transmission Based Precautions literature reviews.

2.1 Patient Placement/Assessment for Infection Risk

The potential for transmission of infection must be assessed at the patient’s entry to the care area.  If hospitalised or in a care home setting this should be continuously reviewed throughout the stay/period of care. The assessment should influence placement decisions in accordance with clinical/care need(s).

Patients who may present a cross-infection risk in any setting includes those:

• With diarrhoea, vomiting, an unexplained rash, fever or respiratory symptoms.
• Known to have been previously positive with a Multi-drug Resistant Organism (MDRO) e.g MRSA, CPE.
• Who have been hospitalised (inpatient) outside Scotland in the last 12 months.

Isolation facilities should be prioritised depending on the known/suspected infectious agent (refer to Aide Memoire - Appendix 11).  All patient placement decisions and assessment of infection risk (including isolation requirements) must be clearly documented in the patient notes.

The clinical judgement and expertise of the staff involved in a patient's management and the Infection Prevention and Control Team (IPCT) or Health Protection Team (HPT) should be sought particularly for the application of TBPs e.g. isolation prioritisation when single rooms are in short supply. 

Hospital settings:

• Isolation of infectious patients can be in specialised isolation facilities, single room isolation, cohorting of infectious patients where appropriate, ensuring that they are separated by at least 3 feet (1 metre) with the door closed.
• Signage should be used on doors/areas to communicate isolation requirements and prevent entry of unnecessary visitors and non-essential staff.
• Infectious patients should only be transferred to other departments if medically necessary.  If the patient has an infectious agent transmitted by the airborne/droplet route then if possible/tolerated the patient should wear a surgical face mask during transfer.
• Receiving department/hospital and transporting staff must be aware of the necessary precautions.

Care home settings:

• Residents should remain in their bedroom whilst considered infectious (as described above) and the door should remain closed (if unable to isolate this should be documented).
• If transfer to hospital is required the ambulance service should be informed of the infectious status of the resident.
• Advice on resident’s clinical management should be sought from GP,  and infection prevention and control management sought from the HPT.
• Avoid unnecessary transfer of residents within/between care areas.

Staff cohorting; consider assigning a dedicated team of care staff to care for patients in isolation/cohort rooms/areas as an additional infection control measure during outbreaks/incidents. This can only be implemented if there are sufficient levels of staff available (so as not to have a negative impact on non-affected patients’ care).

Before discontinuing isolation; individual patient risk factors should be considered (e.g. there may be prolonged shedding of certain microorganisms in immunocompromised patients).

Primary care/out-patient settings:

• Patients attending these settings with suspected/known infection/colonisation should be prioritised for assessment/treatment e.g. scheduled appointments at the start or end of the clinic session. Infectious patients should be separated from other patients whilst awaiting assessment and during care management by at least 3 feet (1m). 
• If transfer from a primary care facility to hospital is required the ambulance service should be informed of the infectious status of the patient.

Further information can be found in the patient placement literature review.

2.2 Safe Management of Patient Care Equipment in an Isolation Room/Cohort Area

• Use single-use items if possible.
• Reusable non-invasive care equipment should be dedicated to the isolation room/cohort area and decontaminated prior to use on another patient Section 1.5. Safe Management of Care Equipment
• An increased frequency of decontamination should be considered for reusable non-invasive care equipment when used in isolation/cohort areas.

For how to decontaminate non-invasive reusable equipment see Appendix 7.

Note: Scottish Ambulance Service (SAS) and Scottish National Blood Transfusion Service adopt practices that differ from those stated in the National Infection Prevention and Control Manual.

2.3 Safe Management of the Care Environment

Routine environmental decontamination

Hospital/Care home setting:

Patient isolation/cohort rooms/area must be decontaminated at least daily, this may be increased on the advice of IPCTs/HPTs. These areas must be decontaminated using either:

• a combined detergent/disinfectant solution at a dilution of 1,000 parts per million available chlorine (ppm available chlorine (av.cl.)); or
• a general purpose neutral detergent in a solution of warm water followed by disinfection solution of 1,000ppm av.cl.

Manufacturers’ guidance and recommended product "contact time" must be followed for all cleaning/disinfection solutions .

Increased frequency of decontamination/cleaning schedules should be incorporated into the environmental decontamination schedules for areas where there may be higher environmental contamination rates e.g.

• toilets/commodes particularly if patients have diarrhoea; and
• “frequently touched” surfaces such as door/toilet handles and locker tops, over bed tables and bed rails.

Vacated rooms should also be decontaminated following an AGP. Clearance of infectious particles after an AGP is dependent on the ventilation and air change within the room. In an isolation room with 10-12 air changes per hour (ACH) a minimum of 20 minutes is considered pragmatic; in a side room with 6 ACH this would be approximately one hour. Advice should be sought from IPCT.

Patient rooms must be terminally cleaned following resolution of symptoms, discharge or transfer. This includes removal and laundering of all curtains and bed screens.

Primary care/Out-patient settings:

The extent of decontamination between patients will depend on the duration of the consultation/assessment, the patients presenting symptoms and any visible environmental contamination. 

Equipment used for environmental decontamination must be either single-use or dedicated to the affected area then decontaminated or disposed of following use e.g. cloths, mop heads.

Terminal decontamination

Following patient transfer, discharge, or once the patient is no longer considered infectious:

Remove from the vacated isolation room/cohort area, all:

• healthcare waste and any other disposable items (bagged before removal from the room);
• bedding/bed screens/curtains and manage as infectious linen (bagged before removal from the room); and
• reusable non-invasive care equipment (decontaminated in the room prior to removal) Appendix 7.

The room should be decontaminated using either:

• a combined detergent disinfectant solution at a dilution (1,000ppm av.cl.); or
• a general purpose neutral detergent clean in a solution of warm water followed by disinfection solution of 1,000ppm av.cl..

The room must be cleaned from the highest to lowest point and from the least to most contaminated point.

Manufacturers’ guidance and recommended product "contact time" must be followed for all cleaning/disinfection solutions .

Unless instructed otherwise by the IPCT there is no requirement for a terminal clean of an outpatient area or theatre recovery.

Note: Scottish Ambulance Service (SAS) and Scottish National Blood Transfusion Service adopt practices that differ from those stated in the National Infection Prevention and Control Manual.

2.4 Personal Protective Equipment (PPE): Respiratory Protective Equipment (RPE)

PPE must still be used in accordance with SICPs when using Respiratory Protective Equipment. See Chapter 1.4 for PPE use for SICPs. 

Further information on best practice for PPE use for TBPs can be found in Appendix 16.

Where it is not reasonably practicable to prevent exposure to a substance hazardous to health (as may be the case where healthcare workers are caring for patients with suspected or known airborne micro-organisms) the hazard must be adequately controlled by applying protection measures appropriate to the activity and consistent with the assessment of risk. If the hazard is unknown the clinical judgement and expertise of IPC/HP staff is crucial and the precautionary principle should apply.

Respiratory Protective Equipment (RPE) i.e. FFP3 and facial protection, must be considered when a patient is admitted with a known/suspected infectious agent/disease spread wholly by the airborne route and when carrying out aerosol generating procedures (AGPs) on patients with a known/suspected infectious agent spread wholly or partly by the airborne or droplet route.

The following risk categorisation is the minimum requirement for staff groups that require FFP3 fit testing. NHS Boards can add to this for example where high risk units are present. This categorisation is inclusive of out of hours services.

National Priority Risk Categorisation for face fit testing with FFP3

Level 1 – Preparedness for business as usual

Staff in clinical areas most likely to provide care to patients who present at healthcare facilities with an infectious pathogen spread by the airborne route; and/or undertake aerosol generating procedures i.e. A&E, ICU, paediatrics, respiratory, infectious diseases, anaesthesia, theatres, Chest physiotherapists, Special Operations Response Team (Ambulance), A&E Ambulance Staff, Bronchoscopy Staff, Resuscitation teams, mortuary staff.

Level 2 – Preparedness in the event of emerging threat

Staff in clinical setting likely to provide care to patients admitted to hospital in the event of an emerging threat e.g. Medical receiving, Surgical, Midwifery and Speciality wards, all other ambulance transport staff.

In the event of an ‘Epidemic/Pandemic’ Local Board Assessment as per their preparedness plans will apply.

The decision to wear an FFP3 respirator/hood should be based on clinical risk assessment e.g task being undertaken, the presenting symptoms, the infectious state of the patient, risk of acquisition and the availability of treatment.

For a list of organisms spread wholly or partly by the airborne (aerosol) or droplet routes see Appendix 11.

Further information can be found in the aerosol generating procedures literature review.

All tight fitting RPE i.e FFP3 respirators must be:

• Single use (disposable) and fluid-resistant.NB. Valved respirators may be shrouded or unshrouded. Respirators with unshrouded valves are not considered to be fluid-resistant and therefore should be worn with a full face shield if blood or body fluid splashing is anticipated.
• Compatible with other facial protection used i.e. protective eyewear so that this does not interfere with the seal of the respiratory protection. Regular corrective spectacles are not considered adequate eye protection. If wearing a valved, non-shrouded FFP3 respirator a full face shield/visor must be worn.
• Changed after each use. Other indications that a change in respirator is required include: if breathing becomes difficult; if the respirator becomes wet or moist, damaged; or obviously contaminated with body fluids such as respiratory secretions.
• Fit tested (by a competent fit test operator) on all healthcare staff who may be required to wear a respirator to ensure an adequate seal/fit according to the manufacturers’ guidance.
• Fit checked (according to the manufacturers’ guidance) every time a respirator is donned to ensure an adequate seal has been achieved.

The poster below gives further information on compatibility of facial hair and FFP3 respirators and can be used when fit testing and fit checking.

Further information regarding fitting and fit checking of respirators can be found on the Health and Safety Executive website.

In the absence of an anteroom/lobby remove FFP3 respirators in a safe area (e.g. outside the isolation/cohort room/area).

All other PPE should be removed in the patient care area.

Powered respirator hoods are an alternative to FFP3 respirators for example when fit testing cannot be achieved.

Powered hoods must be:

• single use (disposable) and fluid resistant;
• the filter must be enclosed with the exterior and the belt able to withstand disinfection with 10,000ppm av.cl.

FFP3 respirator or powered respirator hood:

• may be considered for use by visitors if there has been no previous exposure to the infected person or infectious agent; but
• must never be worn by an infectious patient(s) due to the nature of the respirator filtration of incoming air not expelled air.

Further information can be found in the Respiratory Protective Equipment (RPE) literature review and the Personal Protective Equipment (PPE) for Infectious Diseases of High Consequence (IDHC) literature review.

Frameworks to support the assessing and recording of staff competency in PPE for HCID are available in the resources section of the NIPCM.

2.5 Infection Prevention and Control during care of the deceased

The principles of SICPs and TBPs continue to apply whilst deceased individuals remain in the care environment. This is due to the ongoing risk of infectious transmission via contact although the risk is usually lower than for living patients.

Washing and/or dressing of the deceased should be avoided if the deceased is known or suspected to have an invasive streptococcal infection, viral haemorrhagic fevers or other Group 4 infectious agents. See Appendix 12. Mandatory - Application of transmission based precautions to key infections in the deceased.

Staff should advise relatives of the precautions following viewing and/or physical contact with the deceased and also when this should be avoided.

Deceased individuals known or suspected to have a Group 4 infectious agent should be placed in a sealed double plastic body bag with absorbent material placed between each bag. The surface of the outer bag should then be disinfected with 1000ppm av.cl before being placed in a robust sealed coffin.

Post mortem examination should not be performed on a deceased individual known or suspected to have Group 4 infectious agents.  See Appendix 12. Mandatory - Application of transmission based precautions to key infections in the deceased”. Blood sampling can be undertaken in the mortuary by a competent person to confirm or exclude this diagnosis.  Refer to Section 2.4 for suitable PPE. 

 

The purpose of this chapter is to support the early recognition of potential infection incidents and to guide IPCT/HPTs in the incident management process within care settings; (that is, NHSScotland, independent contractors providing NHS services and private providers of care).

This guidance is aligned to the Management of Public Health Incidents: Guidance on the Roles and Responsibilities of NHS led Incident Management Teams (2017)

Built environment incidents/outbreaks

HPS are currently working towards delivery of comprehensive evidence-based guidance which will form Chapter 4 of the National Infection Prevention and Control Manual (NIPCM) on the built environment and decontamination. 

In the interim two Aide-Memoires have been produced to provide best practice recommendations to be implemented in the event of a healthcare water-associated or healthcare ventilation-associated infection incident/outbreak.  These will ensure clinical staff, estates and facilities staff, and Infection Prevention and Control Teams (IPCT) have an understanding of the preventative measures required and the appropriate actions that should be taken.

Prevention and management of healthcare water-associated infection incidents/outbreaks

Prevention and management of healthcare ventilation-associated infection incidents/outbreaks

 

 

3.1 Definitions of Healthcare Infection Incident, Outbreak and Data Exceedance

The terms ‘incident’ and ‘Incident Management Team’ (IMT) are used as generic terms to cover both incidents and outbreaks

A healthcare infection incident may be:

An exceptional infection episode

• A single case of any serious illness which has major implications for others (patients, staff and/or visitors), the organisation or wider public health e.g. infectious diseases of high consequence such as VHF or XDR-TB.

See literature review for Infectious Diseases of High Consequence (IDHC)

A healthcare associated infection outbreak

• Two or more linked cases with the same infectious agent associated with the same healthcare setting over a specified time period.

or

• A higher than expected number of cases of HAI in a given healthcare area over a specified time period.

A healthcare infection exposure incident

• Exposure of patients, staff, public to a possible infectious agent as a result of a healthcare system failure or a near miss e.g. ventilation, water or decontamination incidents.

A healthcare infection data exceedance

• A greater than expected rate of infection compared with the usual background rate for that healthcare location.

Further information can be found in the literature review Healthcare infection incidents and outbreaks in Scotland.

3.2 Detection and recognition of a Healthcare Infection incident/outbreak or data exceedance

An early and effective response to an actual or potential healthcare incident, outbreak or data exceedance is crucial. The local Board IPCT and HPT should be aware of and refer to the national minimum list of alert organisms/conditions. See Appendix 13.

3.2.1 Assessment

Following detection/recognition of an incident a member of IPCT or HPT will:

• Undertake an initial assessment, utilising the Healthcare Infection Incident Assessment Tool (HIIAT) - Appendix 14, gather epidemiological data and clinical assessment information on the patients condition as per:
  • Section 1.1
  • Section 2.1

• Based on this initial assessment the IPCT/HPT may choose to convene a Problem Assessment Group (PAG) to further assess and determine if an IMT is required.
  • If the HIIAT is assessed as Green and there is no HPS support required then this should be reported as per DL(2019)23. If support is required this should be communicated to HPS. The HIIAT Green reporting protocol, procedure and template is available from the resources section.
  • If the HIIAT is assessed Amber or Red report to HPS. Healthcare Infection Incident and Outbreak Reporting Template (HIIORT) - Appendix 15 should be completed.

3.2.2 Investigation

The IPCT/HPT will establish an IMT if required.

• In the NHS hospital setting the ICD will usually chair the IMT and lead the investigation of healthcare incidents.  Where there are implications for the wider community e.g. TB or measles, or rare events such as CJD or a Hepatitis B/HIV look back, or where there is an actual or potential conflict of interest with the hospital service, the CPHM may chair the IMT. A draft agenda for the IMT is available.
• The membership of the IMT will vary depending on the nature of the incident.
• A case definition for the purpose of the incident will be agreed. A case definition should include the following: the people involved (e.g. patients, staff); the symptoms/pathogen/infection (e.g. with Group A Streptococci); the place (e.g. care area(s) involved); and a limit of time (e.g. between January and March year/date). The case definition(s) should be regularly reviewed and refined (if required) throughout the incident investigation as more information becomes available.
• The investigation of the incident should include: an ongoing epidemiological investigation; the nature and characteristics of the incident e.g. a microbiological investigation; and how cases were exposed to the infective agent or other hazard to inform control measures.
• Identify any change(s) in the system: staffing, procedures/processing, equipment, suppliers. A step-by-step review of procedure(s). A generic outbreak checklist is available.
• Identify and count all cases and/or persons exposed: This includes the total number of confirmed/probable/possible exposed cases. An incident/outbreak data collection tool is available.
• The IMT should receive and discuss all information gathered and epidemiological outputs e.g. an epidemiological (epi) curve, a timeline and a ward map to:
  • Generate hypotheses as to which cross-transmission pathways and clinical procedures may be involved.
  • Determine whether additional case finding and control measures may be necessary.
  • Confirm that all incident control measures are being applied effectively and are sufficient.
• If staff screening is being considered as part of the investigation DL (2020)1 must be followed.
• HAI deaths, which pose an acute and serious public health risk, must be reported to the Procurator Fiscal, refer to SGHD/CMO(2014)27.
• If no new cases arise and any remaining cases are considered to no longer pose a risk, the IMT should agree on actions prior to resumption of normal service.
• Once the incident is over the IMT/NHS Board should evaluate and report on the effectiveness and efficiency of incident management using the Hot Debrief Tool.This is not a mandatory requirement but for the purpose of sharing lessons learned across Scotland.

The IMT Chair, in discussion with the IMT, should determine whether further reporting on the incident and the incident management is required i.e. SBAR Report and full IMT report template are available in the resources section of the NIPCM website.  

The purpose of this addendum is to provide additional guidance to chapters 1,2 and 3 for NNUs

4.1 Placement of neonates/assessment for infection risk

Undertake assessment for infection risk at the point of entry into the unit before placement of the neonate is decided. This assessment is the minimal microbiological testing required and any additional testing would be determined by the clinical presentation of the neonate. The potential for transmission of infection should be continuously reviewed throughout the stay/period and must be documented in the clinical notes.

Neonates who present as a cross infection risk include those who:

• have been transferred from another unit in Scotland with an ongoing incident/outbreak or
• were born outside Scotland
• have previously been positive with a Multidrug Resistant Organism (MDRO)

From mothers who have:

• been hospitalised outside Scotland in the previous 12 months
• had no antenatal care
• been previously positive with a MDRO e.g. Multidrug Resistant Staphylococcus Aureaus (MRSA) or Carbapenemase Producing Enterobacteriaceae (CPE)

If a neonate is considered to be a cross infection risk then the clinical judgement of those involved in the management of the baby should assess the placement by prioritising the incubator/cot in a suitable area pending investigation i.e. place in a single room or cohort area/room with a wash hand basin.

Information/advice must be given to parents/carers of all neonates; particularly during outbreaks/incidents

4.2 Healthcare infection, incidents, outbreaks and data exceedence

In addition to the definitions in Chapter 3, in a neonatal unit investigation by IPCT is also required if:

• a single case of infection with an alert organism is identified
• two or more cases of colonisation with the same organism; linked in time and place are identified

Assigning staff to nurse only infected/colonised neonates may also be required. During outbreaks or incidents the ratio of staff to neonates may need to increase and it may be necessary to restrict admissions to the area.

4.3 Personal care of neonates

Due to the vulnerability of some neonates the use of tap water for personal care requires consideration and this is outlined in Guidance for neonatal units (NNUs) (levels 1, 2 & 3), adult and paediatric intensive care units (ICUs) in Scotland to minimise the risk of Pseudomonas aeruginosa infection from water. For example, an assessment should be made on the neonate’s condition and whether tap water can be used or if an alternative, such as sterile water, is considered more appropriate.

In addition incubators/cots should not be placed near any water source where spraying or splashing may occur.

Reference 1

The use of the word 'Persons' can be used instead of ‘Patient’ when using this document in non-healthcare settings.

Abrasion

A graze. A minor wound in which the surface of the skin or a mucous membrane has been worn away by rubbing or scraping.

Aerosol Generating Procedures (AGPs)

Certain medical and patient care activities that can result in the release of airborne particles (aerosols). AGPs can create a risk of airborne transmission of infections that are usually only spread by droplet transmission.

See Appendix 11, footnote 3 for further information

Aerosols

See Airborne particles

Airborne (aerosol) transmission

The spread of infection from one person to another by airborne particles (aerosols) containing infectious agents.

Airborne particles (aerosols)

Very small particles that may contain infectious agents. They can remain in the air for long periods of time and can be carried over long distances by air currents. Aerosols can be released during aerosol generating procedures (AGPs).

 

Alcohol based hand rub (ABHR)

A gel, foam or liquid containing one or more types of alcohol that is rubbed into the hands to inactivate microorganisms and/or temporarily suppress their growth.

Alert organism

An organism that is identified as being potentially significant for infection prevention and control practices. Examples of alert organisms include Meticillin Resistant Staphylococcus aureus (MRSA), Clostridioides difficile (C.diff) and Group A Streptococcus.

 

Alveolar

Refers to the alveoli which are the small air sacs in the lungs. Alveoli are located at the ends of the air passageways in the lungs, and are the site at which gas exchange takes place.

Anteroom

An area with a door from/to the outside corridor and a second door giving access to the patient area (where both doors will never be open at the same time).

Antimicrobial

An agent that kills microorganisms, or prevents them from growing. Antibiotics and disinfectants are antimicrobial agents.

Antimicrobial hand wipes

Hand wipes that are moistened with an antimicrobial solution/agent at a concentration sufficient to inactivate microorganisms and/or temporarily suppress their growth.

Aseptic Technique

A healthcare procedure designed to minimise the risks of exposing the person being cared for to pathogenic micro-organisms during simple (e.g dressing wounds) and complex care procedures (e.g. surgical procedures).

Asymptomatic

Not showing any symptoms of disease but where an infection may be present.

Autoclave

Machine used for sterilising re-usable equipment using superheated steam under pressure.

Bay

A partly enclosed area within a ward containing one bed (single bay) or multiple beds (multi-bed bay).

Blood Borne Viruses (BBV)

Viruses carried or transmitted by blood, for example Hepatitis B, Hepatitis C and HIV.

Body Fluids

Fluid produced by the body such as urine, faeces, vomit or diarrhoea.

Carbapenemase Producing Enterobacteriaceae (CPE)

A group of bacteria that have become extremely resistant to antibiotics including those called carbapenems.

Care setting

Includes but is not limited to general practice, dental and pharmacy (primary care), acute-care hospitals, emergency medical services, urgent-care centres and outpatient clinics (secondary care), specialist treatment centres (tertiary care), long-term care facilities such as nursing homes and skilled nursing facilities (community care), and care provided at home by professional healthcare providers (home care).

Care staff

Any person who cares for patients, including healthcare support workers and nurses.

Central Decontamination Unit (CDU)

A large, centralised facility for the decontamination and re-processing of re-usable medical equipment e.g. surgical instruments.

Central Vascular Catheter (CVC)

An intravenous catheter that is inserted directly into a large vein in the neck, chest or groin to allow intravenous drugs and fluids to be given and to allow blood monitoring.

Chlorine

A chemical that is used for disinfecting, fumigating and bleaching.

Cleaning

The removal of any dirt, body fluids (blood, vomit) etc by use of an appropriate cleaning agent such as detergent.

Clinical wash hand basin

A sink designated for hand washing in clinical areas.

Clostridioides difficile (C.diff)

An infectious agent (bacterium) that can cause mild to severe diarrhoea which in some cases can lead to gastro-intestinal complications and death.

Cohort area

An area (room, bay, ward) in which two or more patients (a cohort) with the same confirmed infection are placed. A cohort area should be physically separate from other patients.

Colonisation

The presence of bacteria on a body surface (such as the skin, mouth, intestines or airway) that does not cause disease in the person or signs of infection.

Conjunctivae

Mucous membranes that cover the front of the eyes and the inside of the eyelids.

Contact transmission

The spread of infectious agents from one person to another by contact. When spread occurs through skin-to-skin contact, this is called direct contact transmission. When spread occurs via a contaminated object, this is called indirect contact transmission.

Contaminated

The presence of an infectious agent on a body surface; also on or in clothes, bedding, surgical instruments or dressings, or other inanimate articles or substances including water and food.

Cross-infection/Cross-transmission

Spread of infection from one person to another.

Decontamination

Removing, or killing pathogens on an item or surface to make it safe for handling, re-use or disposal, by cleaning, disinfection and/or sterilisation.

Detergent

A chemical cleansing agent that can dissolve oils and remove dirt.

Diarrhoea

3 or more loose or liquid bowel movements in 24 hours or more often than is normal for the individual.

Direct contact transmission

Spread of infectious agents from one person to another by direct skin-to-skin contact.

Disinfectant

A chemical used to reduce the number of infectious agents from an object or surface to a level that means they are not harmful to health.

Disinfection

A process, for example using a chemical disinfectant, to reduce the number of infectious agents from an object or surface to a level that means they are not harmful to your health.

Domestic waste

Waste produced in the care setting that is similar to waste produced in the home.

Droplet

A small drop of moisture, larger than airborne particle, that may contain infectious agents. Droplets can be released when a person talks, coughs or sneezes, and during some medical or patient care procedures such as open suctioning and cough induction by chest physiotherapy. It is thought that droplets can travel around 1 metre (3 feet).

Droplet transmission

The spread of infection from one person to another by droplets containing infectious agents.

Emollient

An agent used to soothe the skin and make it soft and supple. 

Enhanced single room (with en-suite facilities and ventilated lobby)

This is a single room with space for one patient and contains a bed; locker/wardrobe; clinical wash-hand basin, en-suite shower, WC and wash-hand basin and has a ventilation system that prevents uncontrolled escape of infectious aerosols from the room to adjacent areas and a lobby with positive pressure ventilation. 

It can also provide a degree of dilution of infectious aerosols in the room for the safety of staff and visitors. 

The room should have extract ventilation that exceeds its supply, such that gaps in its fabric leak inwards not outwards. 

Enhanced single room (with en-suite facilities)

This is a single room with space for one patient and contains a bed; locker/wardrobe; clinical wash-hand basin, en-suite shower, WC and wash-hand basin and has a ventilation system that prevents uncontrolled escape of infectious aerosols from the room to adjacent areas. 

It can also provide a degree of dilution of infectious aerosols in the room for the safety of staff and visitors. 

The room should have extract ventilation that exceeds its supply, such that gaps in its fabric leak inwards not outwards. 

 

En-suite

A room containing a sink and toilet and sometimes a shower/wetroom or bath.

En-suite single-bed room

A room with space for one patient and containing a bed; locker/wardrobe, clinical wash-hand basin, en-suite shower, WC and wash-hand basin.

Exceptional infection episode

A single case of an infection that has severe outcomes for an individual patient OR has major infection control/public health implications e.g. infectious diseases of high consequence such as extensively drug resistant tuberculosis (XDR-TB).

Excretions

Waste products produced by the body such as urine and faeces (bowel movements).

Exposure

The condition of being exposed to something that may have a harmful effect such as an infectious agent.

Exposure Prone Procedures (EPPs)

Certain medical and patient care procedures where there is a risk that injury to the healthcare worker may result in exposure of the patient’s open tissues to the healthcare worker’s blood e.g the healthcare worker’s gloved hands are in contact with sharp instruments, needle tips or sharp tissues inside a patient’s body.

FFP3

Respiratory protection that is worn over the nose and mouth designed to protect the wearer from inhaling hazardous substances, including airborne particles (aerosols). FFP stands for filtering facepiece. There are three categories of FFP respirator: FFP1, FFP2 and FFP3. An FFP3 respirator or hood provides the highest level of protection, and is the only category of respirator legislated for use in UK healthcare settings.

Fit Testing

A method of checking that a tight-fitting facepiece respirator fits the wearer and seals adequately to their face. This process helps identify unsuitable facepieces that should not be used.

Fluid-resistant

A term applied to fabrics that resist liquid penetration, often used interchangeably with 'fluid-repellent' when describing the properties of protective clothing or equipment.

GP

General practitioner (your family doctor)

Group 4 Infections

Definition taken from the HSE Approved list of biological agents www.hse.gov.uk/pubns/misc208.pdf

Group 4 infections cause severe human disease and is a serious hazard to employees; it is likely to spread to the community and there is usually no effective prophylaxis or treatment available.

 

 

Hand Hygiene

The process of decontaminating your hands using either alcohol based hand rub or liquid soap and water.

Hand wash station

A wash hand basin with mixer tap, paper towels and non-antimicrobial liquid soap in a single use container designed for hand washing use only.

Health Protection Team (HPT)

A team of healthcare professionals whose role it is to protect the health of the local population and limit the risk of them becoming exposed to infection and environmental dangers. Every NHS board has a HPT.

Healthcare Associated Infection (HAI)

Infections that occur as a result of medical care, or treatment, in any healthcare setting.

Healthcare associated infection outbreak

Two or more linked cases associated with the same infectious agent, within the same healthcare setting, over a specified time period; or a higher than expected number of cases in a given healthcare area over a specified time period.

Healthcare infection data exceedance

A greater than expected rate of infection compared with the usual background rate for the place and time where the incident has occurred.

Healthcare infection exposure incident

An exposure of patients, staff, or the public to a possible infectious agent, as a result of a healthcare system failure or near misses e.g. ventilation, water or a decontamination incident.

Healthcare Waste

Waste produced as a result of healthcare activities for example soiled dressings, sharps.

Hospital infection incident assessment tool (HIIAT)

Used by the IPCT or HPT to assess every healthcare infection incident i.e. all outbreaks and incidents including decontamination incidents or near misses in any healthcare setting (that is the NHS, independent contractors providing NHS Services and private providers of healthcare).

Hygiene Waste

Waste that is produced from personal care. In care settings this includes feminine hygiene products, incontinence products and nappies, catheter and stoma bags. Hygiene waste may cause offence due to the presence of recognisable healthcare waste items or body fluids. It is usually assumed that hygiene waste is not hazardous or infectious.

Hypochlorite

A chlorine-based disinfectant such as bleach

Immunisation

To provide immunity to a disease by giving a vaccination.

Immunocompromised patient/individual

Any person whose immune response is reduced or deficient, usually because they have a disease or are undergoing treatment. People who are immunocompromised are more vulnerable to infection.

Impervious

Cannot be penetrated by liquid.

Incident Management Team (IMT)

A multidisciplinary group with responsibility for investigating and managing an incident. 

Indirect contact transmission

The spread of infectious agents from one person to another via a contaminated object.

Infection

Invasion of the body by a harmful organism or infectious agent such as a virus, parasite, bacterium or fungus.

Infection Prevention and Control Team (IPCT)

A multidisciplinary team responsible for preventing, investigating and managing an infection incident or outbreak.

Infectious agent

Any organism, such as a virus, parasite, bacterium or fungus, that is capable of invading body tissues, multiplying, and causing disease.

Infectious Diseases of High Consequence (IDHC)

An Infectious Disease of high consequence (IDHC) typically causes severe symptoms requiring a high level of care and a high case-fatality rate, there may not be effective prophylaxis or treatment.  IDHC are transmissible from human to human (contagious) and capable of causing large-scale epidemics or pandemics. 

Invasive device

A device which penetrates the body, either through a body cavity or through the surface of the body. Central Venous Catheters (central line), Peripheral Arterial Lines and Urinary Catheters are examples of invasive devices.

Invasive procedure

A medical/healthcare procedure that penetrates or breaks the skin or enters a body cavity.

Isolation

Physically separating patients to prevent the spread of infection.

Isolation Suite/Room

An isolation room/suite consists of enhanced en-suite single bed rooms:

An en-suite single bed room is defined as: consisting of  a bed; locker/wardrobe; clinical wash-hand basin and en-suite shower,wc and wash-hand basin.  (In new build, space for a social support zone for overnight stay and a clinical support zone is also provided).

• Enhanced single room (with ensuite facilities) is the same as an en-suite single-bed room but with a ventilation system that prevents uncontrolled escape of infectious aerosols from the room to adjacent areas.It can also provide a degree of dilution of infectious aerosols in the room for the safety of staff and visitors. The room should have extract ventilation that exceeds its supply, such that gaps in its fabric leak inwards not outwards.<br>

• Enhanced single room (with en-suite facilities and ventilated lobby) is the same as an enhanced single room (with ensuite facilities) but with a lobby having positive pressure ventilation. 

J

No terms

K

No terms

L

No terms

Microorganism (microbe)

Any living thing (organism) that is too small to be seen by the naked eye. Bacteria, viruses and some parasites are microorganisms.

Mode of transmission

The way that microorganisms spread from one person to another. The main modes or routes of transmission are airborne (aerosol) transmission, droplet transmission and contact transmission.

MRSA

Meticillin Resistant Staphylococcus aureus are strains of infectious agent (bacterium) Staphylococcus aureus that are resistant to the antibiotic meticillin.

Mucocutaneous exposure

An incident in which the mucous membranes (e.g mouth, nose, eyes) are exposed to blood/other body fluid

Mucous membranes/mucosa

The surfaces lining the cavities of the body that are exposed to the environment such as the lining of the mouth and nose.

Multi-bed room

A room that contains more than one bed.  It is best practice for these to have both en-suite toilet with shower, clinical wash-hand basin and doors to the main ward area.

Needle safety device

Any device designed to reduce the risk of injury from needles. This may include needle-free devices or mechanisms on a needle, such as an automated resheathing device, that cover the needle immediately after use.

Negative pressure room

A room which maintains permanent negative pressure i.e air flow is from the outside adjacent space (e.g corridor) into the room and then exhausted to the outside.

Nitrile

A synthetic rubber material used to make non-latex gloves.

Non-intact skin

Skin that is broken by cuts, abrasions, dermatitis, chapped skin, eczema etc.

Non-intact skin exposure

An incident in which non-intact skin is exposed to blood or body fluids.

Non-sterile procedure

Care procedure that does not need to be undertaken in conditions that are free from bacteria or other microorganisms.

Occupational exposure

Exposure of healthcare workers or care staff to blood or body fluids in the course of their work.

Organism

Any living thing that can grow and reproduce, such as a plant, animal, fungus or bacterium.

Outbreak

When two or more people have the same infection, or more people than expected have the same infection.  The cases will be linked by a place and a time period.

Pathogen

Any disease-producing infectious agent.

Patient cohorting

Placing a group of two or more patients (a cohort) with the same suspected or confirmed infection in the same room or area.

Percutaneous injury

An injury caused by a sharp instrument or object such as a needle or scalpel, cutting or puncturing the skin.

Personal Protective Equipment (PPE)

Equipment a person wears to protect themselves from risks to their health or safety, including exposure to infections e.g. disposable gloves and disposable aprons.

Problem Assessment Group (PAG)

A group that is convened by the Infection Prevention and Control Team (IPCT)/Health Protection Team (HPT) to assess a healthcare incident/outbreak/data exceedence and determine if further action

The assessment and outcome may be:

• HIIAT Green - continue to monitor
• HIIAT Amber/Red - IMT required

Pyrexia

Fever. Rise in body temperature above the normal level >37.2°.

Q

No terms

Recapping/Re-sheathing

To put a needle or other sharp object back into its plastic sheath or cap. Also known as ‘re-sheathing’.

Respiratory droplets

A small droplet, such as a particle of moisture released from the mouth during coughing, sneezing, or speaking.

Respiratory Protective Equipment (RPE)

There are two main types of RPE: respirators and breathing apparatus.

• Respirators are devices worn over the nose and mouth or head and are designed to filter the air breathed in to protect the wearer from inhaling hazardous substances, including airborne particles (aerosols). The most commonly used item of RPE in healthcare settings is an FFP3 respirator.

• Breathing apparatus provides a supply of breathing quality air from an external source such as a cylinder or an air compressor.

Safer sharp

A medical sharps device which has been designed to incorporate a feature or mechanism that minimises and/or prevents the risk of accidental injury.  Other terms include (but are not limited to) safety devices, safety-engineered devices and safer needle devices.

Sanitary fittings

All sinks and furniture in a bathroom, such as a toilet, bath, shower etc.     

Secretions

Any body fluid that is produced by a cell or gland such as saliva or mucous.

Segregated

Physically separating or isolating from other people.

Sepsis

A life threatening condition that arises when the body’s response to a severe complication of infection e.g. pneumonia (lung infection) injures its own tissues and organs. This can lead to multiple organ failure and death. Early recognition, treatment and management is key to successful patient outcomes.

Sharp

A ‘sharp’ is a device or instrument  used in healthcare settings such as needles, lancets and scalpels which are necessary for the exercise of specific healthcare activities and are able to cut, prick and/or have the potential to cause injury.

 

Sharps incident

A type of percutaneous injury caused by a sharp instrument or device which cuts or penetrates the skin. 

Sharps injury

See percutaneous injury.

Significant occupational exposure

A percutaneous, mucocutaneous exposure or non-intact skin (abrasions, cuts, eczema) exposure to blood/other body fluids from a source that is known (or later found to be) positive for a bloodborne virus infection.

Significant sharps incident

An incident which involves a used needle that has exposed, or may have exposed, the employee to blood/body fluids.

Single-bed room

A room with space for one patient and usually contains as a minimum: a bed; locker/wardrobe; clinical wash-hand basin.

Spore

A reproductive cell produced by fungi and some types of bacteria under certain environmental conditions. Spores can survive for long periods of time and are very resistant to heat, drying and chemicals.

Staff cohorting

A dedicated team of healthcare staff who care for a cohort of patients, and do not care for any other patients.

Sterile

Free from live bacteria or other microorganisms

Sterile procedure

Care procedure that is undertaken in conditions that are free from bacteria or other microorganisms.

Sterilisation

The procedure of making some object free of all germs, live bacteria or other microorganisms (usually by heat or chemical means).

Surgical face mask

A disposable fluid-resistant mask worn over the nose and mouth to protect the mucous membranes of the wearer’s nose and mouth from splashes and infectious droplets and also to protect patients.  When recommended for infection control purposes a 'surgical face mask' typically denotes a fluid-resistant (Type IIR) surgical mask.

Swan-neck

Way of closing bag by tying in a loop and securing with a zip tie to make a handle.

Terminal decontamination

Cleaning/decontamination of the environment following transfer/discharge of a patient, or when they are no longer considered infectious, to ensure the environment is safe for the next patient or for the same patient on return.

U

No terms

Variable pressure room

Room where it is possible to change the pressure from positive to negative or vice-versa by switch.

Vascular access devices

Any medical instrument used to access a patient’s veins or arteries such as a Central Venous Catheter or peripheral vascular catheter.

Ward

An area forming a division of a care setting (or a suite of rooms) shared by patients who need a similar type of care.

X

No terms

Y

No terms

Z

No terms