1.1 Explain employees’ roles and responsibilities in relation to the prevention and control of infection You have a responsibility to take care of your own health and safety and that of others who may be affected by your actions such as the people you support, their family, friends and your work colleagues. The health and safety at work act 1974 requires workers to:
Take reasonable care their own safety and that of others
Cooperate with the employer in respect of health and safety matters Not intentionally damage any health and safety equipment or materials provided by the employer Attend training by the employer
Use protective equipment provided by the employer
When considering your responsibilities relating to infection within your work setting you need to:
If someone acquires an infection, your responsibilities will focus on controlling and limiting the spread of the infection. You will need to be more vigilant and record and report any changes in a person condition.
1.2 Explain employers’ responsibilities in relation to the prevention and control infection There is a general duty of care placed on all employers under health and safety legislation, which gives employers the responsibility to protect employee from danger and harm. Employers must: Provide a safe workplace
Carry out risk assessments to assess the dangers of certain work activities
Provide training for staff
Provide personal protective equipment
Ensure regular health and safety checks are under taken
There responsibilities extend to employers protecting employee from the risks posed by biological hazards such as blood, body fluids and associated infection. Your employer will have put infection, prevention and control policies and procedures in place for staff to adhere. Your manager will have a good understanding of the general care of the people within the setting and will be able to respond appropriately in the event of a possible infection outbreak. Care managers have a responsibility to the people within the care of the organisation and should undertake regular checks on the cleanliness of the setting, monitor hand washing practice, know whom to contact in event of an infection outbreak and report infection to correct authority.
2.1 Outline current legislation and regulatory body standards which are relevant to the prevention and control of infection
Within the HASAWA (Health and Safety at Work Act) there are regulations that have a relevance to the prevention and control of infection. These include: Control of Substances Hazardous to Health Regulations 2002 (COSHH) Reporting of Injuries, Diseases and Dangerous Occurrence Regulations 1995 (RIDDOR)
2.2 Describe local and organisational policies relevant to the prevention and control of infection
Every health and care setting should have a clear policies and procedures for prevention and control of infection. The policies will be tailored to meet the requirements of each care setting and may include some of the following information: Roles and responsibilities of key members of staff in the organisation Personal hygiene requirements and best hand hygiene
How to apply standard precautions
Safe handling and disposal of sharps, clinical waste and personal protective equipment
How to report and record accidents and incidents
Your work place policy should be reflecting what standards should be expected for the area where you are required to work. It is important for you to be familiar with the information in your organisation infection, prevention and control policy. It is your responsibility to read and follow your organisation policy.
3.1 Describe procedures and systems relevant to the prevention and control of Infection
It can help you identify specific procedures and systems if you split the focus of the prevention and control measures into two areas, which are: The environment and equipment
Care environment and the equipment used within the care environment will differ depending on the setter where you work. The areas and environment you work will have to be kept clean to reduce the risk of infection. The level of cleanliness required will depend on the type of activities being undertaken. There are three levels of cleaning: General cleaning and decontamination
3.2 Explain the potential impact of an outbreak of infection on the individual and the organisation
The outbreak of an infection within a care setting can have serious consequences for both people and the care organisation. People who acquire HCAI’s will require medical treatment to deal with the infection such as antibiotic therapy but antibiotics can have side effects such as allergic reactions, diarrhoea and nausea. Some pathogenic organisms have become resistant to antibiotics causing the so-called superbug MRSA which needs stronger antibiotics to fight it. The effect of infections are not only physical, they can also have a mental impact because people who acquire infections often think they are ‘dirty’ which can lower their self-esteem. Some infections may require the patient to be isolated may require the patient to be isolated from others to help prevent and control the spread of infection. A person who has to be isolated from others may feel depressed because of the lack of social interaction. It is important that care workers perform regular checks on isolated people to help reduce the risk of becoming depressed.
For organisations, an infection outbreak can prove to be an expensive affair with the cost of treatment and a prolonged stay in hospital; what’s more it
can ruin the organisations reputation. If an investigation, conducted following the infection outbreak, identifies poor practice or negligence, the HSE has the right to prosecute people, which could result in a fine or imprisonment.
Every care worker has a duty of care to ensure that they minimise the risks of a person from acquiring an HCAI. The main way this can achieved is by having an awareness of their responsibilities under the organisations infection prevention and control policy, adopting safe practices including the use of standard precautions, affective hand washing and attending regular training.
4.1 Define the term risk
There are a number of hazards that have the potential to cause harm. Hazards that come from living organism, such as humans, are called biological hazards or biohazards and include the organism found in body fluids such as HIV virus.
4.2 Outline potential risks of infection within the workplace
The risk if acquiring an infection increases within the health and social care sectors because these sectors deal with many people who are more susceptible to the risk of infection due to their conditions, when considering the potential risks of infections, you will need to think about: The person being supported
Relatives, friends and visitors
You and colleagues
4.3 Describe the process of carrying out a risk assessment
An infection control risk assessment is like other risk assessments, will identify the potential biohazards within the workplace. The risks these biohazards pose, who may be at risk and how the biohazards can be removed or reduce. The HSE gives a five step guide to risk assessment:
Identify the hazard
Decide who might be harmed and how precaution
Evaluate the risk and decide on precautions
Record the findings and implement them
Review the assessment and evaluate if necessary
4.4 Explain the importance of carrying out a risk assessment
Under the Health and Safety at Work Act 1974 employers have a legal responsibility to protect the health and safety of their employees and anyone else using the workplace. A risk assessment is one of the most important assessments an employer can undertake to protect their employees and individuals as well as their organisations reputation. Health and safety legislation does not require employers to eliminate all risks but does require them to protect people as far as is reasonably practicable, failure to undertake a risk assessment is not only illegal but it also risk the health and safety of all people within the workplace, especially the most vulnerable people, the people you are providing care for.
5.1 Demonstrate correct use of PPE
5.2 Describe different types of PPE
There are many different types of PPE. This includes:
Uniforms – in some care establishments it is a requirement for staff to wear uniforms. Uniforms must be clean at the start of every shift and should be changed if they become soiled during the shift.
Gloves – there are many different types of gloves available for care workers to use such as latex, nitrile and vinyl latex gloves are the most common gloves used within healthcare organisations.
Aprons- plastic aprons can be placed over the uniform to help prevent the uniform from becoming soiled when performing activities such as personal care, toileting and wound care. Plastic aprons are water proof; they also provide protection when assisting people to have a bath and handling body fluids.
Masks – these are disposal and come in different types:
First made from paper. The mask forms a shield that may be pleated and has two ties for around the head and a flexible nose bridge. The second type of mask is similar to the first type but has ear loops instead of ties. The third type of mask has a moulded cup shape held in place by an elastic cord around the head.
Visor – like face masks, visor are not commonly used outside clinical environment where they can be used to help protect the care worker from the risk of splashing from blood or body fluids.
Goggles – these can provide care workers with eye protection when dealing with blood or body fluids.
Hats/caps – surgical hats can be wither disposable or reusable. Disposable hats come in a range of colours and different sizes which can be adjusted to fit different size heads by securely fasting the ties at the back of the hat. Reusable hats are made from cotton material which can be laundered at high temperatures.
Shoes – most care workers are required to ear sensible shoes that are not open-toed and do not have high heels. You should follow your organisations policy on footwear.
5.3 Explain the reasons for use of PPE
Personal protective equipment is used to protect both the care worker and the individual receiving care. It is important to ensure that when using PPE, it is used correctly and for the purpose it was designed.
Uniform – are worn to reduce the risk of pathogenic organisms being transferred from the outside environment to clothing to patient.
Gloves are a form of physical barrier between the care workers skin and all others surface including the patient’s skin, blood and body fluids.
Aprons are also a form of physical barrier, between the care worker and other surfaces such us people you are supporting, food and cleaning.
Masks protect you from patients’ blood and body fluids aerosol during surgical procedure and in settings where bacteria and viruses that may be present.
Hat/caps are worn in the operating theatre because research has shown that care workers keep their hair clean and tidy, the risk of infection is small.
5.4 State current relevant regulations and legislation relating to PPE
Under the Health and Safety at Work Act 1974, it is made clear that if items of PPE are required then they must be provided free of charge by the employer. Under the Health and Safety at Work Act 1974 there are specific regulations which specifically address PPE. These regulations are: The Personal Protective Equipment at Work Regulations 2002
The Management of Health and Safety at Work Regulations 1999 The Control of Substance Hazardous to Health Regulations 2002 (COSHH)
5.5 Describe employees’ responsibilities regarding the use of PPE
Employees are to take reasonable care for their own health and safety and of others who may be affected by their acts or omissions at work. This responsibility extends to PPE, which employees must wear to protect themselves and others including patients. Employees’ specific responsibilities include:
Attend training provided by the employer relating to how to use PPE
Using PPE in accordance with the training
Taking reasonable care of all PPE provided by the employer
Returning PPE to the correct storage accommodation provided for it after use
Reporting to the employer any loss or obvious defect as soon as possible
5.6 Describe employers’ responsibilities regarding the use of PPE
Employers have a general duty to ensure, as far as reasonably possible, the health, safety and welfare at work of all employees. Employers also have a duty of care under the Personal Protective Equipment at Work Regulations 2002. These include the following requirements: Properly assessing the need for PPE and assessing PPE before it is used to ensure it is suitable. This involves identifying the hazard and the type of PPE what could be used. Providing free PPE to employees. Employers cannot ask employees to pay for PPE, however if an employee leaves and does not return an item of PPE to the employer, the employer can deduct the cost of replacing the equipment from any wages owed, providing this information has been made clear in the contract of employment.
Ensuring PPE is maintained and stored properly make sure equipment is well looked after and stored correctly. Maintence may include cleaning, examination, replacement, repair and testing. The wearer may be able to carry out simple maintenance (for example cleaning) but more detailed repairs must be carried out by a competent person. All maintenance, repairs and replacement cost are responsibility of the employer. Providing employers with adequate information, instruction and/or training on its uses. Training will include making sure that anyone using PPE is aware of why it is required, when it is to be used, repaired or replaced and its limitations. Employees must be trained to use PPE properly and understand how to perform basic checks. Ensuring employee’s follows the training provides and that they use the PPE provided and fully investigate non-compliance.
5.7 Describe the correct practice in the application and removal of PPE
It is important that PPE is put on and removed correctly. Failing to remove contaminated PPE can result in infections, spreading and defeats that purpose of using the equipment in the first place.
Uniforms should be fresh every day and should be applied just before starting a shift as this will help reduce the risk of pathogenic organisms from the outside environment being taken into the care setting. Before putting on the uniform you should ensure that you wash your hands and dry them thoroughly. Uniforms should be removed at the end of the shift or after contaminated with blood or body fluids. When removing a uniform you should try to avoid touching the front of the uniform as much as possible, as this will reduce the risk of transferring pathogenic organisms from the uniform to skin. Once removed, the uniform should be place in appropriate place such as a laundry sack. Always wash your hands after removing your uniform.
Gloves should be applied to clean and dry hands. There are five steps in applying gloves and removing them: Check gloves before putting them on; never use gloves with holes or tears. Check that they are not cracked or faded. Pull gloves on, making sure they fit properly if you are wearing a gown, put them over the cuffs. Take them off by pulling from the cuff; this turns the glove inside out. Pull off the second glove while still holding the first, so that the two gloves are folded together inside out. Dispose of them in the correct waste disposal container and wash your hands. When removing gloves, it is important to follow these important steps to reduce the risk of cross-infections.
Aprons – the neck strap of the apron should be placed over the head and the waist ties should be tied at the back. When removing you pull at the end neck strap and the waist strap until they snap, making sure that you keep hold of the apron so that it does not fall to the floor. The apron can be scrunched up into a ball in your gloved hands, once the apron is in a ball, it can be placed in your gloved hand and gloves can be removed.
Masks – once you have selected the mask you can gently pull the mask open by pulling on the top and the bottom of the mask from the middle remembering not to touch the front of the mask. It is important not to touch the front of the mask and only handle the mask by its ties. The mask should be removed by untying the bottom ties and then the top ties and moving it away from your face by holding the ties.
Visors/goggles – both should be checked to ensure they are clean before they are placed on your face. You may have to adjust to fit your head and face. Once removed they have to be cleaned and decontaminated as appropriate and dried thoroughly. Once dried, the goggles or visor should be returned to the approved accommodation.
Hats – theatre hats should be the first piece of clothing worn when preparing to enter the operating theatre department. The hat should be places on the head, ensuring all hair is covered; the hat can be secured into position by the ties at the back. Once the hat is ready to be removed, it can be pulled off the head by using the ties and disposed of.
Shoes – these should be the last item of clothing to put on because of the risk of cross-infection. Once shoes have been put on, hands should be washed and dried thoroughly. Once removed, shoes should also be cleaned and decontaminated as required, not just left lying around.
You should always wash and dry your hands thoroughly when you use PPE and once it has been removed.
5.8 Describe the correct procedure for disposal of used PPE
Some PPE items such as uniform, visors, goggles and footwear are non-disposable and should be cleaned, decontaminated, dried and stored in the appropriate accommodations ready for their next use. You need to make sure that you are familiar with the company’s policy for dealing with such items.
Masks, hats, gloves and aprons are all classed as clinical waste and are regarded as high risk items; they should therefore be disposed of carefully to reduce the risk of cross-infection.
6.1 Describe the key principles of good personal hygiene
You should ensure that you wash, shower or bath and wear a clean uniform for work every shift you work. Fingernails need particular attention because they can harbour bacteria and you should ensure that they are kept clean, short and free from nail polish or false extensions. Hair does not normally pose an infection risk if it is kept clean and should be washed on a regular basis, long hair should be tied back away from your face. Jewellery should not be worn for work because items such as rings and watches can harbour bacteria and could scratch the individuals you are supporting.
You should take every opportunity to promote and encourage good personal hygiene for people you provide care for. You should encourage people to wash their hands after toileting activities and to wash every day, you should offer people the opportunity to bath or shower if it is appropriate to their condition. 6.2 Demonstrate good hand washing technique
6.3 Describe the correct sequence for hand washing
When washing your hands, it is important to have a sequenced, step by step approach to help reduce the risk of missing an area of skin. Before starting the hand-washing sequence, you must ensure you are fully prepared and have everything ready. You should follow these steps: 1. Remove watches and rings.
2. Select the correct water temperature, as it needs to be comfortable enough for you to pace your hands underneath without having to withdraw them because it is too hot or too cold.
3. Wet both hands.
4. Apply a full measure of hand wash solution but not too much and rub palms of the hands together. 5. Rub one hand over the back of the other, remembering to rub the spaces between the fingers. 6. Rub the finger tips together to clean the tips, the back and the front of the fingers 7. Rub the finger tips in a circular motion against the palm of opposite hand and then swap. If a wedding ring is being worn, pay attention to this area and ensure you wash under the ring. 8. Interlock the thumbs ensuring that the thumbs and the wrist have contact with the hand solution. 9. Once al the surface of the hands have been washed, ensure the hands are thoroughly rinsed to remove any soap residue, as this can make the skin sore and dry. 10. Depending on the type of hand washing activity being undertaken steps 4-9 may need to be repeated. 11. Turn the taps off using the elbows or foot pedal, some modern taps turn on and off automatically when movement is detected by a motion sensor. 12. Thoroughly dry the hands on absorbent disposable paper towels.
6.4 Explain when and why hand washing should be carried out
Hand washing activities must be performed regularly to help prevent and control the spread of infection, but there are certain times when it is recommended that care workers wash their hands. These are: Before putting on a clean uniform or PPE
Before any aseptic procedure
After patient contact
After removing PPE
After going to the toilet
Before handling food
After finishing work
After smoking if the care worker smokes.
Before washing your hands, you will need to consider the hand washing method
required for what you have just done or for that you are about to do.
There are three types of hand-wash methods used within healthcare setting:
Routine hand washing using soap
Disinfectant hand washing using anti-microbial agent
Aseptic hand washing using surgical scrub solution such as Hydrex or Betadine
6.5 Describe the types of products that should be used for hand washing
There are many different types of hand washing solutions on the market and you employer will purchase the one which they believe best meets their requirements.
General hand washing soap
This type of soap is used for routine hand washing and should be in a dispenser unit not a bar because bars of soap harbour bacteria and can lead to the spread of infection.
Disinfectant hand wash
Hand wash solution for disinfectant hand washing procedures such as 2 per cent Chlorhexidine gluconate soap solution is commonly used in clinical areas for clinical purposes.
Surgical scrub solutions
Scrub solutions such as Povidone Iodine (Betadine) and 4 per cent Chlorhexidine gluconate (Hydrex) have a high residual activity and should only be used for aseptic procedures, as these solutions can lead to dry skin and irritations.
Hand gel containing 60-70 per cent alcohol kills 99.99 per cent of all bacteria and most gels contain moisturisers, emollients and skin protectors to help prevent the skin from drying out.
6.6 Describe correct procedures that relate to skincare
Maintain healthy skin is an important step in the prevention and control of infection; however constant washing and the wearing of gloves can cause the skin to dry out. To help prevent this, moisturising cream should be applied to hands following routine hand washing procedures. If you notice that your skin has become sore, you should report this to your manager but you should not stop practising good hand hygiene practice. If the condition continues to worsen, you should contact your GP, any reaction to hand washing solution, gel or after wearing gloves should also be recorded in an incident book or in accordance to you company’s policy.