National Infection Prevention and Control Manual
The NHSScotland National Infection Prevention and Control Manual (NIPCM) was first published on 13 January 2012, by the Chief Nursing Officer (CNO (2012)1), and updated on 17 May 2012 (CNO (2012)1 Update).
The NIPCM was endorsed on 3 April 2017 by the Chief Medical Officer (CMO), Chief Pharmaceutical Officer (CPO), Chief Dental Officer (CDO) and Chief Executive Officer of Scottish Care.
The NIPCM provides guidance to all those involved in care provision and should be adopted for infection prevention and control practices and procedures. The national manual is mandatory for NHSScotland. In all other care settings to support with health and social care integration the content of this manual is considered best practice.
The manual aims to:
The NIPCM currently contains guidance on Standard Infection Control Precautions (SICPs), Chapter 1 and Transmission Based Precautions (TBPs), Chapter 2 and Healthcare Infection incidents, outbreaks and data exceedance - Chapter 3. It is planned to further develop the content of the manual.
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.
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:
For assessment of infection risk see Section 2: Transmission Based Precautions.
Further information can be found in the patient placement literature review.
Hand hygiene is considered an important practice in reducing the transmission of infectious agents which cause HAIs.
Hand washing sinks must not be used for the disposal of other liquids. (See Appendix 3 of Pseudomonas Guidance)
Before performing hand hygiene:
*For health and safety reasons, Scottish Ambulance Service Special Operations Reponse 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:
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:
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:
Skin care:
Surgical Hand Antisepsis
Surgical scrubbing/rubbing: (applies to persons undertaking surgical and some invasive procedures)
Perform surgical scrubbing/rubbing before donning sterile theatre garments or at other times e.g. prior to insertion of central vascular access devices.
Hand Hygiene posters/leaflets can be found on the Wash Your Hands of Them website.
Further information can be found in the Hand Hygiene literature reviews:
(The video above demonstrating Surgical Scrubbing using ABHR was produced by Golden Jubilee National Hospital)
Respiratory and cough hygiene is designed to minimise the risk of cross-transmission of respiratory illness (pathogens):
Staff should promote respiratory and cough hygiene helping those (e.g. elderly, children) who need assistance with this e.g. providing patients with tissues, plastic bags for used tissues and hand hygiene facilities as necessary.
Further information can be found in the cough etiquette/respiratory hygiene literature review.
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:
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:
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:
Full body gowns/Fluid repellent coveralls must be:
Further information can be found in the Aprons/Gowns literature review.
Eye/face protection (including full face visors) must:
Further information can be found in the eye/face protection literature review.
Fluid Resistant Type IIR surgical face masks must be:
Further information can be found in:
Footwear must be:
Further information can be found in the footwear literature review.
Headwear must be:
For the recommended method of putting on and removing PPE see Appendix 6.
Further information can be found in the headwear literature review
2Scottish National Blood Transfusion Service (SNBTS) adopt practices that differ from those stated in the National Infection Prevention and Control Manual.
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:
Before using any sterile equipment check that:
Decontamination of reusable non-invasive care equipment must be undertaken:
Adhere to manufacturers’ guidance for use and decontamination of all care equipment.
All reusable non-invasive care equipment must be rinsed and dried following decontamination then stored clean and dry.
Decontamination protocols should include responsibility for; frequency of; and method of environmental decontamination.
An equipment decontamination status certificate will be required if any item of equipment is being sent to a third party e.g for inspection, servicing or repair.
Guidance may be required prior to procuring, trialling or lending any reusable non-invasive equipment.
Further information can be found in the management of care equipment literature review.
For how to decontaminate reusable non-invasive care equipment see Appendix 7.
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:
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.
Clean linen
Linen used during patient transfer
For all used linen (previously known as soiled linen):
For all infectious linen (this mainly applies to healthcare linen) i.e. linen that has been used by a patient who is known or suspected to be infectious and/or linen that is contaminated with blood and/or other body fluids e.g. faeces:
Local guidance regarding management of linen may be available.
All linen that is deemed unfit for re-use e.g torn or heavily contaminated, should be categorised at the point of use and returned to the laundry for disposal.
Further information can be found in the safe management of linen literature review and National Guidance for Safe Management of Linen in NHSScotland Health and Care Environments - For laundry services/distribution.
Further information about linen bagging and tagging can be found in Appendix 8.
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.
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.
Scottish Health Technical Note (SHTN) 3: NHSScotland Waste Management Guidance contains the regulatory waste management guidance for NHSScotland including waste classification, segregation, storage, packaging, transport, treatment and disposal.
The Health and Safety (Sharp Instruments in Healthcare) Regulations 2013 outline the regulatory requirements for employers and contractors in the healthcare sector in relation to the safe disposal of sharps.
Categories of waste:
Waste Streams:
For care/residential homes waste disposal may differ from the categories described above and guidance from local contractors will apply. Refer to SEPA guidance.
Safe waste disposal at care area level:
Always dispose of waste:
Liquid waste e.g. blood must be rendered safe by adding a self-setting gel or compound before placing in an orange lidded leak-proof bin.
Waste bags must be no more than 3/4 full or more than 4 kgs in weight; and use a ratchet tag/or tape (for healthcare waste bags only) using a ‘swan neck’ to close with the point of origin and date of closure clearly marked on the tape/tag.
Store all waste in a designated, safe, lockable area whilst awaiting uplift. Uplift schedules must be acceptable to the care area and there should be no build-up of waste receptacles.
Sharps boxes must:
Local guidance regarding management of waste at care level may be available.
Further information can be found in the safe disposal of waste literature review.
3Not required for boards with an on-site incinerator facility. This applies only to NHS Borders.
The Health and Safety (Sharp Instruments in Healthcare) Regulations 2013 outline the regulatory requirements for employers and contractors in the healthcare sector in relation to:
Sharps handling must be assessed, kept to a minimum and eliminated if possible with the use of approved safety devices.
Manufacturers’ instructions for safe use and disposal must be followed.
Needles must not be re-sheathed/recapped.4
Always dispose of needles and syringes as 1 unit.
If a safety device is being used safety mechanisms must be deployed before disposal.
A significant occupational exposure is:
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:
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.
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.
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.
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.
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:
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:
Care home settings:
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:
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.
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:
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.
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. This is a minimum of 20 minutes in hospital settings where the majority of these procedures occur. 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:
The room should be decontaminated using either:
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.
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.
Staff in primary care/outpatient settings or care homes would not normally be required to wear an FFP3 unless an AGP is being performed when staff should wear a single use FFP3 respirator.
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.
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.
All tight fitting RPE i.e FFP3 respirators must be:
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.
Further information regarding fitting and fit checking of respirators can be found on the Health and Safety Executive website.
Powered respirator hoods are an alternative to FFP3 respirators for example when fit testing cannot be achieved.
FFP3 respirator or powered respirator hood:
Powered hoods must be:
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 IDHC are available in the resources section of the NIPCM.
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)
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. Thiese 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
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
See literature review for Infectious Diseases of High Consequence (IDHC)
A healthcare associated infection outbreak
or
A healthcare infection exposure incident
A healthcare infection data exceedance
Further information can be found in the literature review Healthcare infection incidents and outbreaks in Scotland.
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:
3.2.2 Investigation
The IPCT/HPT will establish an IMT if required.
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
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:
From mothers who have:
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
In addition to the definitions in Chapter 3, in a neonatal unit investigation by IPCT is also required if:
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.
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.
The use of the word 'Persons' can be used instead of ‘Patient’ when using this document in non-healthcare settings.
A graze. A minor wound in which the surface of the skin or a mucous membrane has been worn away by rubbing or scraping.
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
The spread of infection from one person to another by airborne particles (aerosols) containing infectious agents.
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. Airborne particles can be released when a person coughs or sneezes, and during aerosol generating procedures (AGPs).
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.
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.
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.
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).
An agent that kills microorganisms, or prevents them from growing. Antibiotics and disinfectants are antimicrobial agents.
Hand wipes that are moistened with an antimicrobial solution/agent at a concentration sufficient to inactivate microorganisms and/or temporarily suppress their growth.
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).
Not showing any symptoms of disease but where an infection may be present.
Machine used for sterilising re-usable equipment using superheated steam under pressure.
A partly enclosed area within a ward containing one bed (single bay) or multiple beds (multi-bed bay).
Viruses carried or transmitted by blood, for example Hepatitis B, Hepatitis C and HIV.
Fluid produced by the body such as urine, faeces, vomit or diarrhoea.
A group of bacteria that have become extremely resistant to antibiotics including those called carbapenems.
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).
Any person who cares for patients, including healthcare support workers and nurses.
A large, centralised facility for the decontamination and re-processing of re-usable medical equipment e.g. surgical instruments.
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.
A chemical that is used for disinfecting, fumigating and bleaching.
The removal of any dirt, body fluids (blood, vomit) etc by use of an appropriate cleaning agent such as detergent.
A sink designated for hand washing in clinical areas.
An infectious agent (bacterium) that can cause mild to severe diarrhoea which in some cases can lead to gastro-intestinal complications and death.
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.
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.
Mucous membranes that cover the front of the eyes and the inside of the eyelids.
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.
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.
Spread of infection from one person to another.
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.
A chemical cleansing agent that can dissolve oils and remove dirt.
3 or more loose or liquid bowel movements in 24 hours or more often than is normal for the individual.
Spread of infectious agents from one person to another by direct skin-to-skin contact.
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.
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.
Waste produced in the care setting that is similar to waste produced in the home.
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).
The spread of infection from one person to another by droplets containing infectious agents.
An agent used to soothe the skin and make it soft and supple.
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.
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.
A room containing a sink and toilet and sometimes a shower/wetroom or bath.
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.
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).
Waste products produced by the body such as urine and faeces (bowel movements).
The condition of being exposed to something that may have a harmful effect such as an infectious agent.
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.
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.
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.
A term applied to fabrics that resist liquid penetration, often used interchangeably with 'fluid-repellent' when describing the properties of protective clothing or equipment.
General practitioner (your family doctor)
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.
The process of decontaminating your hands using either alcohol based hand rub or liquid soap and water.
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.
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.
Infections that occur as a result of medical care, or treatment, in any healthcare setting.
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.
A greater than expected rate of infection compared with the usual background rate for the place and time where the incident has occurred.
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.
Waste produced as a result of healthcare activities for example soiled dressings, sharps.
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).
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.
A chlorine-based disinfectant such as bleach
To provide immunity to a disease by giving a vaccination.
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.
Cannot be penetrated by liquid.
A multidisciplinary group with responsibility for investigating and managing an incident.
The spread of infectious agents from one person to another via a contaminated object.
Invasion of the body by a harmful organism or infectious agent such as a virus, parasite, bacterium or fungus.
A multidisciplinary team responsible for preventing, investigating and managing an infection incident or outbreak.
Any organism, such as a virus, parasite, bacterium or fungus, that is capable of invading body tissues, multiplying, and causing disease.
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.
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.
A medical/healthcare procedure that penetrates or breaks the skin or enters a body cavity.
Physically separating patients to prevent the spread of infection.
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).
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Any living thing (organism) that is too small to be seen by the naked eye. Bacteria, viruses and some parasites are microorganisms.
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.
Meticillin Resistant Staphylococcus aureus are strains of infectious agent (bacterium) Staphylococcus aureus that are resistant to the antibiotic meticillin.
An incident in which the mucous membranes (e.g mouth, nose, eyes) are exposed to blood/other body fluid
The surfaces lining the cavities of the body that are exposed to the environment such as the lining of the mouth and nose.
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.
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.
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.
A synthetic rubber material used to make non-latex gloves.
Skin that is broken by cuts, abrasions, dermatitis, chapped skin, eczema etc.
An incident in which non-intact skin is exposed to blood or body fluids.
Care procedure that does not need to be undertaken in conditions that are free from bacteria or other microorganisms.
Exposure of healthcare workers or care staff to blood or body fluids in the course of their work.
Any living thing that can grow and reproduce, such as a plant, animal, fungus or bacterium.
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.
Any disease-producing infectious agent.
Placing a group of two or more patients (a cohort) with the same suspected or confirmed infection in the same room or area.
An injury caused by a sharp instrument or object such as a needle or scalpel, cutting or puncturing the skin.
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.
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:
Fever. Rise in body temperature above the normal level >37.2°.
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To put a needle or other sharp object back into its plastic sheath or cap. Also known as ‘re-sheathing’.
A small droplet, such as a particle of moisture released from the mouth during coughing, sneezing, or speaking.
There are two main types of RPE: respirators and breathing apparatus.
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.
Pieces of furniture that are in a bathroom, such as a toilet, bath etc.
Any body fluid that is produced by a cell or gland such as saliva or mucous.
Physically separating or isolating from other people.
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.
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.
A type of percutaneous injury caused by a sharp instrument or device which cuts or penetrates the skin.
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.
An incident which involves a used needle that has exposed, or may have exposed, the employee to blood/body fluids.
A room with space for one patient and usually contains as a minimum: a bed; locker/wardrobe; clinical wash-hand basin.
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.
A dedicated team of healthcare staff who care for a cohort of patients, and do not care for any other patients.
Free from live bacteria or other microorganisms
Care procedure that is undertaken in conditions that are free from bacteria or other microorganisms.
The procedure of making some object free of all germs, live bacteria or other microorganisms (usually by heat or chemical means).
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.
Way of closing bag by tying in a loop and securing with a zip tie to make a handle.
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.
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Room where it is possible to change the pressure from positive to negative or vice-versa by switch.
Any medical instrument used to access a patient’s veins or arteries such as a Central Venous Catheter or peripheral vascular catheter.
An area forming a division of a care setting (or a suite of rooms) shared by patients who need a similar type of care.
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