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Infection control in primary care
[February 21, 2006]

Infection control in primary care


(Practice Nurse Via Thomson Dialog NewsEdge)
Janis Smy is a freelance medical writer

Infection control is high on the primary care agenda for 2006, with new legislation, guidelines and educational initiatives underway or on the near horizon.

The good news for practice nurses is that standard precautions, used properly, are still the mainstay of general practice work. Front-line infection control professionals say that rigorous attention to basic principles such as handwashing, correct use of protective clothing and decontamination of equipment should be enough to protect patients and staff in all but exceptional circumstances.



The onus is on practice nurses to make sure they follow those principles each and every time they see a patient.

Statutory code is on the way


Practice procedures and performance in infection control will come under increasing scrutiny when the new health bill comes into force. The bill, currently at committee stage, will include a statutory code on infection control, and its requirements will be on the inspection list when the Healthcare Commission carries out routine visits to practices and other healthcare organisations.

There are also firm deadlines for making sure every practice has appropriate systems for ensuring the sterility of specula, minor-op equipment and other invasive devices. The relevant legislation is already enacted in Scotland, where practices have until 2009 to demonstrate their compliance. Practices south of the border must have plans in place by 31 March 2007.

Primary care organisations should be considering their response if/when the much-heralded avian flu pandemic strikes, ready to cascade out to front-line staff. And no one in healthcare can afford to be complacent about MRSA and other resistant organisms in the population.

Training programmes

Education is fundamental to good practice and all healthcare staff should be trained in the principles of infection control.1,2

A new online training tool for NHS staff may make the necessary education more accessible. The programme was launched last September by Chief Nurse Christine Beasley at the Infection Control Nurses Association conference, and will be rolled out this year. It covers guidelines and principles, offers case scenarios and includes topics such as hand hygiene, protective clothing, environmental cleanliness and disposal of waste and sharps. Key sections can be printed out for distribution and discussion among colleagues.

Nottingham City PCT was a pilot site for the online programme, and the training was well received, according to infection control nurse specialist Fiona Branton.

'It provides the standard knowledge that everyone in clinical practice needs to have. And because it is online, people have time to go through the package at their own pace,' she explains.

'There are also useful links providing more detailed information on, for example, specific infections.'

Yet another resource is on its way. 'Saving lives', an infection control delivery programme developed last year for acute care, is being adapted for primary care, and should be available in late spring.

NHS Education Scotland offers an

11-module training programme for 'Cleanliness champions in healthcare organisations'. At least one health board - Ayrshire and Arran - recognises completion of the course as an enhanced service under the GP contract.

A similar project related specifically to decontamination in primary care will be available in Scotland this month.

Basic techniques will minimise risk

Bob Wilson, infection control nurse specialist adviser at Ayrshire and Arran, is among those who emphasise the importance of the basic rules.

'Practice nurses can minimise risks simply by observing hand hygiene, correct use of protective equipment, decontamination of instruments and equipment, decontamination of the envir-onment and safe use and disposal of sharps and other clinical waste.'

CNO Ms Beasley agrees. 'Practice nurses just need to make sure they have a sound knowledge of what really matters - and that means the basic techniques such as hand hygiene.'

She is similarly sanguine on the sometimes fraught topic of practice nurse uniforms. 'Ideally, uniforms should be worn outside the clinical environment only in exceptional circumstances. But practice nurses do not always have changing facilities. And, of course, community nurses are, by the nature of their work, out and about in their uniforms every day.'

She urges practice nurses not to go to the supermarket in their uniforms, but accepts that some community staff are likely to buy a newspaper or pint of milk between patients.

She says practice nurses also make a difference through the information they provide for patients and carers. 'Patients and their families often talk to their

practice nurses before going into hospital, and when they come out. And that is an opportunity to spread the word on sensible infection control practices.'

Managing MRSA

Grant Crawshaw, infection control and immunisation clinical nurse specialist at Colchester PCT, is aware of the need for healthcare professionals to provide sensible, realistic information: 'People get very stirred up, particularly when it comes to things like MRSA. I know youngsters who have MRSA, whose parents have been told by health professionals that their children must be segregated at school... That is poor advice and it has a dramatic effect on quality of life.

'I also get regular calls from people worried about visiting friends and family in local hospitals. They want to know if MRSA is on any of the wards and, if so, how do they protect themselves.'

Mr Crawshaw insists that basic infection control methods, scrupulously applied, remain the practice nurse's best option.

'Remember, we don't know for certain who has MRSA and who hasn't, so there is little sense in segregating patients. And there is no justification whatsoever for excluding MRSA-positive people from the practice.

'Of course, if someone has a wound that is heavily contaminated with MRSA, it is common sense to offer treatment at the end of the session. But that would also be best practice for a patient heavily contaminated with Staphylococcus aureus.'

He dismisses the idea of routine MRSA screening for practice staff: 'For a start, it would miss people who simply carry the organism on their hands - and who are most likely to pass it on.'

He warns that the rules are most likely to be broken when practice staff are working to the limit.

'There is no evidence on handwashing in primary care, but we know it is often neglected in the acute sector. I suspect it is just as likely to be overlooked in a very busy general practice.'

Information gap

Mr Crawshaw recognises that gathering information from primary care is the next big challenge for infection control specialists. Data needs to be collected on how general pratice compares with the acute sector: 'Only then will we find out if we really do need to do more in the community to prevent the spread of MRSA and other resistant organisms.'

Further Information

NHS

- Cleanliness Champions programme. www.nes.scot.nhs.uk/hai/programme.htm

- Core Learning Programmes Unit NHS infection control programme.

www.southyorkshire.nhs.uk/clpu/NHS_Infection_Control_handout.pdf

DoH

- Saving lives: www.dh.gov.uk/PolicyAndGuidance/HealthAndSocial

CareTopics/HealthcareAcquired

Infection/HealthcareAcquiredGeneral

Information/SavingLivesDelivery

Programme/fs/en

- Pandemic flu: www.dh.gov.uk/PolicyAndGuidance/Emergency

Planning/PandemicFlu/fs/en

RCN Wipe It Out campaign www.rcn.org.uk/resources/mrsa/healthcarestaff

KEY POINTS

The fundamental principles of infection control are:

- hand hygiene

- correct use of protective clothing/equipment

- decontamination of equipment

- decontamination of the working environment

- safe use and disposal of sharps and other clinical waste.

The practice nurse uniform is not protective clothing - disposable aprons should be worn when needed

Everyone working in healthcare should be trained in infection control. Practice nurses covered by Agenda for Change will be trained at their induction and have ongoing training thereafter

A statutory code on infection control forms part of the new health bill and practices can expect their compliance to be monitored during Healthcare Commission visits

Practices in Scotland have until 2009 to comply with the Glennie framework, which recommends use of disposable instruments, use of central decontamination services and has guidance on practice-based sterilisation equipment. Practices south of the border have until March 2007 to formulate their plans.

Further Information

NHS

- Cleanliness Champions programme. www.nes.scot.nhs.uk/hai/programme.htm

- Core Learning Programmes Unit NHS infection control programme.

www.southyorkshire.nhs.uk/clpu/NHS_Infection_Control_handout.pdf

DoH

- Saving lives: www.dh.gov.uk/PolicyAndGuidance/HealthAndSocial

CareTopics/HealthcareAcquired

Infection/HealthcareAcquiredGeneral

Information/SavingLivesDelivery

Programme/fs/en

- Pandemic flu: www.dh.gov.uk/PolicyAndGuidance/Emergency

Planning/PandemicFlu/fs/en

RCN Wipe It Out campaign www.rcn.org.uk/resources/mrsa/healthcarestaff

KEY POINTS

The fundamental principles of infection control are:

- hand hygiene

- correct use of protective clothing/equipment

- decontamination of equipment

- decontamination of the working environment

- safe use and disposal of sharps and other clinical waste.

The practice nurse uniform is not protective clothing - disposable aprons should be worn when needed

Everyone working in healthcare should be trained in infection control. Practice nurses covered by Agenda for Change will be trained at their induction and have ongoing training thereafter

A statutory code on infection control forms part of the new health bill and practices can expect their compliance to be monitored during Healthcare Commission visits

Practices in Scotland have until 2009 to comply with the Glennie framework, which recommends use of disposable instruments, use of central decontamination services and has guidance on practice-based sterilisation equipment. Practices south of the border have until March 2007 to formulate their plans.

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