Criterion 5.3.4 Infection control
Our health service manages the risk of cross infection in accordance with the current edition of the RACGP Infection control standards for office based practices.
► A. Our staff can describe how our health service ensures that, where necessary, sterile equipment is used in clinical procedures (interview).
► B. Our staff members with designated responsibility for sterilisation procedures can describe in detail how the use of sterile equipment is assured, including where relevant (interview, direct observation):
- provision of an adequate range of disposable equipment
- procedures for having instruments sterilised offsite
- procedures for onsite equipment sterilisation
- monitoring the integrity and validation of the entire sterilisation process and steriliser maintenance
- procedures for safe storage and stock rotation
- education and training of the relevant staff.
► C. Our staff can describe how risks of potential cross infection are managed within our health service, including procedures for (interview, direct observation):
- hand hygiene
- managing a sharps injury
- safe storage and disposal of clinical waste including sharps
- managing blood and body fluid spills
- monitoring ongoing adherence to our infection control processes.
► D. Our staff can describe (interview):
- the routine used by our health service for cleaning, disinfecting and decontaminating the clinical and nonclinical areas of our service
- standard precautions
- additional precautions.
► E. Our health service has a written policy that outlines our service’s infection control procedures (document review).
► F. Subject to their informed consent, the immunisation status of our staff is known to our health service and staff members are offered immunisation appropriate to their roles (document review, interview).
► G. The induction of new staff to our health service ensures they are familiar with standard precautions against infection and related issues appropriate to their roles (document review, interview).
Infection control has a number of aspects. These concern the sterility of clinical equipment, the occupational health and safety of staff, and managing the risk of cross infection in the health service environment.
The health service needs to have a written policy on infection control processes within their service. This written policy needs to include:
- sharps injury management
- blood and body fluid spills management
- hand hygiene
- a regular cleaning schedule describing the frequency of cleaning as well as cleaning products and procedures for clinical and nonclinical areas of the health service
- the provision of sterile instruments whether by the use of disposables, or by onsite or offsite sterilisation of reuseable instruments
- procedures for all aspects of the sterilisation process if instruments are sterilised onsite. For instruments sterilised offsite, procedures covering both sterilisation and transport. There should be procedures for validating or obtaining evidence of validation for all onsite and offsite aspects of sterilisation
- procedures for waste management including the safe storage and disposal of clinical waste (including sharps)
- the appropriate use of standard and additional precautions
- prevention of disease in the workplace by serology and immunisation.
In terms of the sterilisation of equipment, the RACGP Infection control standards for office based practices (4th edition)61 describe sterilisation as the preferred process for the reprocessing all reusable instruments and equipment (noncritical, semicritical, and critical) that can withstand this process regardless of their intended use. If disinfection is used, disinfection can be achieved by thermal (hot water) systems and chemical disinfectants. Disinfecting is not a sterilising process. However, sterilisation is one form of disinfection.
Health services that sterilise onsite need to demonstrate the correct use and maintenance of sterilising equipment.
Where a health service uses offsite sterilisation facilities, the health service needs to document procedures for the safe transport of instruments to and from the health service, and demonstrate that the offsite facility performs the sterilisation correctly and validates its processes (eg. by providing evidence that the facility is accredited by the Australian Council on Healthcare Standards.
Where a health service employs single use disposable instruments, the health service needs to be able to demonstrate that the packaging of instruments is not compromised and the instruments have remained sterile until their use.
In relation to waste management within the health service, the RACGP Infection control standards for office based practices62 define three categories of waste produced by healthcare industries and outline the appropriate disposal mechanism for each.
- Clinical waste – includes discarded sharps; laboratory and associated waste directly involved in specimen processing; human tissues (but excluding hair, teeth, urine and faeces); materials or solutions containing free flowing or expressible blood and animal tissues or carcasses used in research
- Related waste – includes cytotoxic waste, pharmaceutical waste, chemical waste and radioactive waste
- General waste – includes all waste materials that do not fall into the clinical or related waste categories. General waste contaminated with blood or body substances (though not to such an extent that it would be considered clinical waste, ie. not contaminated with expressible blood) may be disposed of through the general waste processes of the health service. Gauze that has blood on it (but which cannot be expressed), used disposable vaginal speculae, cervical spatulae and brushes, and tongue depressors are likely to be the most common items in this category.
The disposal of clinical waste can be achieved as follows.
- For most clinical waste – into a safely located yellow, leak proof container displaying a biohazard symbol
- For sharps – into a safely located yellow, leak proof and puncture resistant container displaying a biohazard symbol (eg. mounted on a wall or on a bench) in all areas where sharps are generated.
Disposal of general waste can be achieved as follows.
- Via a small bin lined with plastic, mounted on the wall or on a bench (to hold contaminated general waste that is not clinical waste) (eg. cervical spatulae, tongue depressors, disposable speculae). It can then be disposed of through the general waste stream
- The usual waste paper bin under the desk can be used for waste not contaminated by blood or body fluids.
Health services need to be aware of any local or state or territory regulations that may require alternative disposal of waste from health services.
Potential infection risks to staff need to be reduced. In this context, it is important for health services to ensure that all staff are familiar with infection control procedures within the health service (including standard and additional precautions, spills management, environmental cleaning), for the health service to know the immunisation status of their staff, and for the health service to ensure that staff are offered appropriate immunisation for their roles.
Standard precautions apply to work practices that assume all blood and body substances are potentially infectious. The NHMRC recommends the use of personal protective equipment including heavy duty protective gloves, gowns, plastic aprons, masks, eye protection or other protective barriers when cleaning, performing procedures, dealing with spills or handling waste (Indicator D).
Additional precautions are used for patients known or suspected to be infected with highly transmissible pathogens. This may be achieved by minimising the length of time such patients are exposed to other patients and staff through the use of masks, by isolating the patient in a separate room or by fast-tracking the patient’s care (Indicator D).
For more information on infection control (including standard precautions, hand cleaning, staff immunisation, sharps injury, sharps and waste management) refer to the current edition of the RACGP Infection control standards for office based practices63 and the Commonwealth Department of Health and Ageing publication Infection control guidelines for the prevention of transmission of infectious diseases in the healthcare setting.
It is important that health services remain alert to changes to guidelines for infection control, and be in a position to implement them promptly. Health services should also have systems for monitoring and obtaining information about national and local infection outbreaks and emerging new risks of cross infection such as the advent of Avian flu, severe acute respiratory syndrome (SARS) and pandemic influenza. This is particularly important for health services in prisons, as this setting increases the risk of exposure to infection and the spread of infectious diseases.
Healthcare services in prisons need to be aware of the risk of infectious diseases from people recently arrived at the facility and also containment processes for the prison as a whole. Staff need to be familiar with their responsibilities to monitor and report disease outbreaks to the relevant state or territory authorities and to respond by implementing appropriate precautions. Appropriate infection control measures need to be instituted to prevent the spread of infectious disease to the wider population in a prison. Furthermore, there needs to be a system in place that allows for the monitoring of threatened outbreaks (eg. varicella, measles, lyssavirus, hendravirus) and emerging disease (eg. SARS, avian influenza or community associated methicillin resistant Staphylococcus aureus).
Further information about infection control is available in the RACGP Infection control standards for office based practices64 (www.racgp.org.au/publications/ standards).