Policy for Personal Protective Equipment for use in Healthcare. Infection Prevention and Control.

Transcription

1 Policy for Personal Protective Equipment for use in Healthcare. Infection Prevention and Control. This policy identifies the appropriate personal protective equipment for staff to use at the required times and for the defined care delivery procedures and processes. This document forms part of the mandatory requirements as identified within the Health and Social Care Act Key Words: Infection Prevention and Control Personal Protective Equipment Version: Adopted by: 4 Infection Prevention and Control Committee Date adopted: January 2015 Main author Antonia Garfoot Name of responsible committee Infection Control Committee Quality Assurance Committee Date issued January 2015 Review date August 2017 Expiry date January 2018 Target audience All LPT staff Type of policy: (tick appropriate box) Clinical Non-clinical Page 1 of 18

2 Contribution List Key individuals involved in developing the document Name Amanda Hemsley Antonia Garfoot Una Willis Fiona Drew Mel Hutchings Designation Senior Nurse Advisor Infection Control Senior Nurse Infection Control Senior Nurse Infection Control Infection Control Nurse Infection Control Nurse Circulated to the following individuals for consultation Name Designation Infection Control Leicestershire Partnership Trust Committee Equality Team Integrated Equality Service Adrian Childs Directorr of Infection Prevention & Control / Chief Nurse Di Postle Trust Lead for Professional Standards Dr Leverment Occupational Health Physician Emma Wallis Lead Nurse CHS Claire Armitage Lead Nurse AMHS Michelle Churchard Senior Advisor LDS Samantha Pearson Service Manager AMHS Louise Carpenter In-patient Lead AMHS Katie Willitts Nurse Specialist FYPC Paul Williams Team Manager Eating Disorders Fran Guerra Senior Matron Kathy Feltham Lead Nurse MHSOP Neil Hemstock Lead Nurse FYPC Janet McNally Team Manager Sarah Clements Matron Loughborough & Hinckley Linda Bull Matron Coalville Community Hospital Sarah Latham Matron Evington Centre Bernadette Keaveney Health Safety and Security Manager Dr. Philip Monk Consultant Communicable Disease Public Health England Page 2 of 18

3 Contents Version control and summary changes 4 Definitions that apply to this policy Summary Introduction Purpose Justification for the document Personal and Protective Equipment for use in Healthcare Training References and associated documents Appendix 1: Guidelines for the use and disposal of Personal and Protective Equipment 13 Appendix 2: National colour coding poster 14 Appendix 3. Process for Donning and Doffing (removal) of PP Page 3 of 18

4 Version Control and Summary of Changes Version Date Comments (description change and amendments) Version 1 March 2008 Infection control policy for the use of Personal Protective Equipment. Version 2 September Guideline review and amendments 2010 Version 3 August 2011 Harmonised in line with LPT LVCRCHS LCCHS (Historical organisations) Version 4 August 2014 Review of policy For further information contact: Infection Prevention and Control Team Page 4 of 18

5 Definitions that apply to this policy Blood borne Due Regard HCW Infection Infectious Inoculation Organisms Pathogen Personal Protective Equipment (PPE) Single-use Device (SUD) Standard Precautions LPT A blood-borne disease is one that can be spread by contamination by blood. Having due regard for advancing equality involves: Removing or minimising disadvantages suffered by people due to their protected characteristics. Taking steps to meet the needs of people from protected groups where these are different from the needs of other people. Encouraging people from protected groups to participate in public life or in other activities where their participation is disproportionately low. Health Care Worker This is an organism present at a site and causes an inflammatory response or where the organism is present in a normally sterile site. Caused by a pathogenic microorganism or agent that has the capability of causing infection Inoculation is the placement of something that will grow or reproduce, and is most commonly used in respect of the introduction of a serum, vaccine, or antigenic substance into the body of a human or animal, especially to produce or boost immunity to a specific disease This is defined as any living thing, in medical terms we refer to bacteria and viruses as organisms. An agent that causes disease, especially a living microorganism such as a bacterium, virus, or fungus Specialised clothing or equipment worn by employees for protection against health and safety hazards A SUD is a device that is intended for one use or on an individual patient during a single procedure, or episode of care Precautions designed preventing the transmission of bloodborne diseases such as human immunodeficiency virus, hepatitis B, and other blood borne pathogens when first aid or health care is provided. The precautions are designed to reduce the risk of transmission of microorganisms from both recognized and unrecognized sources of infection Leicester Partnership Trust Page 5 of 18

6 1.0 Summary of Policy This policy has been developed to give clear guidance to staff in relation to the procedure for the use of Personal Protective Equipment by Leicestershire Partnership Trust (LPT) It describes the process for ensuring the delivery of effective infection prevention and control education and training for all relevant staff groups and is compliant with the NHSLA Standards and Care Quality Commission registration Further guidance for healthcare workers and other staff work in prisons and places of detention can be found in Prevention of Infection & Communicable Disease Control in Prisons & Places of Detention A Manual for Healthcare Workers and other Staff. 2.0 Introduction The principles of protection against blood and body substance are under pinned by the Health and Safety at Work Act (1974). This is reinforced by the Control of Substances Hazardous to Health (COSHH) Regulations (as amended 2002), which require employers to assess the risks associated with the handling of hazardous substances, including pathogenic micro- organisms and legislation from the Health & Safety Executive (HSE) relating to personal protective equipment (PPE) at work. The Personal Protective Equipment Regulations (1992) Everyone involved in providing care within the hospital and community setting should be educated about standard precautions and trained in hand decontamination, the use of personal protective equipment and the safe disposal of sharps (NICE 2012). The risk of acquiring blood-borne pathogens can be minimised by treating blood and other body substances from all patients as potentially infectious and taking precautions to minimise the risk of exposure of non-intact skin or mucous membranes to blood and body substances. Selection of personal protective equipment must be based on an assessment of the risk of transmission of microorganisms to/from the patient, and the risk of contamination of the healthcare practitioners' clothing and skin by patient's blood, body fluids, secretions or excretions, (NICE 2012,CG). The greatest risk of transmission of blood borne viruses is from inoculation injuries, but it is also known to have occurred following splashing of blood onto mucous membranes or damaged skin. In addition to prevention of exposure to blood-borne pathogens it is recognised that healthcare workers (HCWs) should be protected against other pathogens carried in body fluids/solids. The use of personal protective equipment will minimise the spread of infection if used in the management of all body substances. Healthcare workers have a professional responsibility to ensure that personal protective equipment is worn appropriately. (Appendix 1) Page 6 of 18

7 3.0 Purpose The purpose of this policy is to provide staff employed by Leicestershire Partnership Trust (LPT) with a clear and robust process for the use of Personal Protective Equipment. This policy applies to all permanent employees including medical staff who work for LPT including those on bank, agency or honouree contracts. All health professionals should ensure they work within the scope of their professional code of conduct. 4.0 Justification for Document Risk management provides a solid foundation for clinical governance to improve and assure the quality of clinical services for patients (DoH 1999). The use of personal protective equipment to prevent exposure to blood and other body fluids is one example of risk management relating to infection control (NICE 2003); equipment is worn for the task intended /episode of care and then removed. Personal protective equipment is not a substitute for safe systems of work but is complementary to them. The general principles of personal protective equipment are: Prevent HCW becoming a vehicle of transmission of pathogens Prevent bodily substances coming into contact with non- intact skin and mucous membranes Prevent bodily substances coming into contact with intact skin 5.0 Personal Protective Equipment for use in Healthcare The use of personal protective equipment aims to prevent the transmission of blood- borne viruses and other pathogens. After removal of any item of personal protective equipment, it must be disposed of as clinical waste (in the health care setting). In patients' own homes where there is no clinical waste collection and there is only a small amount of PPE then this can be disposed of in household waste. It should be placed into a waste bag then placed into the household waste bag (double bagged). Clinical waste bags must not be disposed of in household waste bags. For larger amounts of PPE waste the responsibility of its disposal sits with the practitioner who has produced it, it should be disposed of at the designated waste collection point for that staff member. Please refer to the LPT policy for the management of waste. Hands must always be washed with liquid soap and water following removal of PPE. If soap not available decontaminate with alcohol sanitiser at wash hands at the earliest opportunity. Employers must ensure that there are adequate stocks of personal protective equipment readily available at all times. Page 7 of 18

8 Gloves The aim of wearing gloves is to: protect hands from contamination by organic matter and micro- organisms protect hands from chemicals that may cause an adverse reaction on the skin reduce the risk of cross-infection by preventing the transfer of organisms from staff to patients, patient to staff and environment to staff. (NICE 2003) Disposable, well fitting, good quality, single-use sterile or non-sterile powderfree, nitrile gloves should be worn for contact with body substances or items contaminated by them, mucous membranes and non-intact skin. Please refer to the LPT Glove Policy. Gloves must be changed: after contact with each patient after different procedures for the same patient and at the end of each activity. If wearing gloves, then aprons must also be worn at the same time (NICE 2003). Gloves must be removed by holding at the cuff and peeling the glove over the hand, then fold the second glove off the hand over the first glove, enclosing the first glove within the second glove and disposing of the gloves into the designated bin for clinical waste (NICE 2012) Hands should be decontaminated following the removal of gloves by hand washing (As outlined in the Hand Hygiene Policy). Gloves for clinical use are designated 'single use' and must never be re-used (NICE 2012). Washing gloves not only reduces the barrier properties of the glove but is also re-processing which is not permitted. Disposable Plastic Aprons Disposable plastic aprons are protective equipment and must be worn to protect the wearer's clothing/uniform. The appropriate colour coded apron should be worn. (Appendix 1) Disposable plastic aprons are worn in the following circumstances. When there is a risk of contamination with blood or body fluids. For direct contact with a patient when providing personal or clinical care. During invasive procedures and minor surgery. For cleaning activities. Whenever gloves are worn. The apron should be put on at the beginning of the activity i.e. patient contact or cleaning, and then removed at the end. Aprons should be single use for close Page 8 of 18

9 patient contact (including contact with babies and children) surgery, or patient treatment. White coats must not be worn. Following completion of the above procedures(s) the apron must be removed and discarded into a clinical waste bin (NICE 2003). In patients own homes where there is no clinical waste collection then dispose of in household waste. It should be placed into a waste bag then placed into the household waste bag (double bagged). Clinical waste bags must not be disposed of in household waste bags One disposable plastic apron should not come into contact with more than one patient Micro-organisms will survive for a sufficient time to allow cross-infection to occur if the apron is worn in caring for more than one patient. Staff must not leave the clinical area or patient s home wearing disposable plastic aprons. Masks General surgical facemasks must be worn: During procedures likely to cause splashing of body substances into the mouth or nose of the HCW. By staff during procedures when an aerosol from body fluids may be created. By staff to protect the patient from potential shedding of microorganisms from the HCW during minor surgery. FFP3 Masks are not required for general nursing care but should be used in the event of a pandemic influenza (as per protocol) Masks must only be handled by their strings and should be handled as little as possible. They must NOT be worn around the neck or be removed from the face except when they are to be discarded. If the mask becomes contaminated with body fluids then it must be changed immediately. Masks must never be reused and should be changed between each patient, once removed they must be disposed of into a clinical waste bin. In patients' own homes where there is no clinical waste collection then waste must be bagged and returned to the centre for disposal. Page 9 of 18

10 Eye Protection / Face Visors Goggles, visors or protective spectacles must be worn to protect the eyes from; Aerosol or splash contamination from body substances/parts e.g. nails surgery, bladder washouts. Aerosol or splash contamination from chemicals Eye protection must fit correctly and be comfortable to wear. It must allow for uncompromised vision. Some of these items may not be disposable. The appropriate method of decontamination must be implemented before re-use (see manufacturer s instructions or LPT Cleaning and Decontamination Policy). Prescription spectacles are inadequate protection unless fitted with side protectors and therefore eye protection/face visors should be worn over the top of spectacles. Forearm Protection Forearm protection should be available for use in areas that there is a risk of injury. It should be used in conjunction with a detailed plan of care to minimise injuries from scratches and bites. Forearm protection is intended for single use and should be disposed of as clinical waste. Arm protection must remain fitted at the wrist, keeping hands free to undertake hand hygiene. 6.0 Training There is a need for training identified in this policy. In accordance with the classification of training outlined in the Trust Human Resources and Organisational Development Strategy this training has been identified as mandatory and role development training. The course directory e source link below will identify: Who the training applies to, delivery method, the update frequency, learning outcomes and a list of available dates to access the training. Page 10 of 18

11 7.0 References and associated documents LPT policies via intranet. The website can be accessed at Centres for Disease Control. Recommendations for the prevention of HIV transmission in health care settings. MMWR 1987; 37: 24. Centers for Disease Control and Precautions. Hospital Infection Control Advisory Committee. Guideline for isolation precautions in hospitals. Infect ContrHosp Epidemiology 1996; 17: Department of Health. Control of Substances Hazardous to Health (COSHH) Department of Health. Immunisation against infectious disease. London: HMSO,1992. Health and Safety Executive (HSE) (1992) the Personal Protective Equipment Regulation. Hospital Infection Society. Acquired immune deficiency syndrome: recommendations of a working party of the Hospital Infection Society. J Hosp Inf 1990; 15:7-34. Infection Control Nurses Association 2003 Protective Clothing Guidelines. Lynch P, Jackson MM, Cummings MJ, Stamm WE. Rethinking the role of isolation practices in the prevention of nosocomial infections. Ann Int Med 1987;107: Medical Devices Bulletin SN 9825 June 1998 National Institute for Clinical Excellence (NICE). Infection Control: Work Wear Personal Protective Equipment Policy (2007) National Institute for Clinical Excellence (NICE). Infection Prevention and Control of healthcare associated infections in Primary and Community Care (March 2012) Olsen RJ, Lynch P, Coyle MB, Cummings J, Borete T, Stamm WE. Examination gloves as barriers to hand contamination in clinical practice. J Am Med Ass 1993; 270 (3): Royal College of Nursing. Universal Precautions. London: RCN, Saghafi L, Raselli P, Francillon C, Francioli P. Exposure to blood during various procedures: results of two surveys before and after implementation of universal precautions. Am J Inf Contr 1992; 20 (2): UK Health Departments. Guidance for clinical health workers: protection against infection with HIV and hepatitis viruses. Recommendations of the Expert Advisory Group on AIDS. London: HMSO, Prevention of Infection & Communicable Disease Control in Prisons & Places of Detention A manual for Healthcare Workers and other Staff. August Page 11 of 18

12 Health Protection Agency. HPA Gateway Reference: HPA11-02.DH Gateway reference: Page 12 of 18

13 Appendix 1 GUIDELINES FOR THE USE AND DISPOSAL OF PERSONAL PROTECTIVE EQUIPMENT GENERAL PRINCIPLES: To prevent the transmission of blood-borne viruses and to prevent the transmission of other Pathogens. Prevent HCW becoming a vehicle of transmission Prevent body substance contact with non-intact skin and mucous membranes Prevent body substance contact with Gloves Must be worn: When in contact with body fluids and substances Mucous membranes Disposable plastic aprons For direct contact with a patient when providing personal or clinical care For cleaning activities and bed making Aprons must be worn if wearing gloves Surgical face Masks Procedures likely to cause splashing of body substances into the mouth and nose of the HCW Procedures when an aerosol from body fluids may be created To protect the patient from exposure to risk of infection from HCW Eye Protection (or face visors) Aerosol or splash contamination of body substances Aerosol or splash contamination from chemicals Arm protection Procedures likely to cause probable scratching / biting to HCW Gloves must be changed after contact with each patient and at the end of each procedure Single use items should not come into contact with more than one patient, and be disposed of after use Personal Protective Equipment must be disposed of into a clinical waste bin Page 13 of 18

14 Appendix 2 National Patient Safety Agency National colour coding scheme for hospital cleaning materials and equipment All NHS organisations should adopt the colour code below for cleaning materials. All cleaning items, for example, cloths (re-usable and disposable), mops, buckets, aprons and gloves, should be colour coded. This also includes those items used to clean catering departments. Bathrooms, washrooms, showers, toilets, basins and bathroom floors General areas including wards, departments, offices and basins in public areas Yellow Catering departments, ward kitchen areas and patient food service at ward level Isolation areas

15 Appendix 3 Process for the donning and Doffing (removal) of PPE The risk of acquiring blood-borne pathogens can be minimised by treating blood and other body substances from all patients as potentially infectious and taking precautions to minimise the risk of exposure of non-intact skin or mucous membranes blood and body substances. Personal protective equipment (known as PPE) is specialised clothing or equipment worn by employees for the protection against health and safety hazards. Selection of personal protective equipment must be based on an assessment of the risk of transmission of microorganisms to/from the patient, and the risk of contamination of the healthcare practitioner clothing and skin by patients blood, body fluids, secretions or excretions. Healthcare workers have a professional responsibility to ensure that person Protective equipment is worn appropriately Donning and D offing (removal) of PPE Putting on and removing Personal Protective Equipment The level of PPE used will vary based on the procedures being carried out and not all items of PPE will always be required. Standard Infection Control Precautions (SIPs) apply at all times. The order given here for putting on PPE is practical but the order for putting on is less critical than the order of removal. Donning PPE a) Gown (or apron [as shown] if not Aerosol Generating Procedure [AGP]) Fully cover torso from neck to knees, arms to end of wrists, and wrap around the back Fasten at back of neck and waist In order to wear a FFP3 mask, you should have been FIT tested before to know that the mask works. b) FFP3 respirator (or surgical mask if not Aerosol Generating Procedure [AGP]) Secure ties or elastic bands at middle of head and neck Fix flexible band to nose bridge Fit snug to face and below chin Fit-check respirator 24 November 2014 Donning and removal of PPE

16 c) Goggles or face shield (Aerosol Generating Procedure [AGP] and as appropriate after risk assessment) Place over face and eyes adjust to fit d) Disposable gloves Extend to cover wrist and gown if worn 24 November 2014 Donning and removal of PPE

17 Doffing PPE Removal (Doffing) of PPE The order for removing PPE is important to reduce cross contamination so the order outlined below always applies even if not all items of PPE have been used: a) Gloves Assume the outside of the glove is contaminated Grasp the outside of the glove with the opposite gloved hand; peel off Hold the removed glove in gloved hand Slide fingers of the ungloved hand under the remaining glove at wrist Peel second glove off over the first glove Discard appropriately a b) Gown or apron Assume the gown / apron front and sleeves are contaminated: Unfasten or break ties Pull gown / apron away from the neck and shoulders, touching the inside of gown only Turn the gown inside out Fold or roll into a bundle and discard appropriately c) Goggles or face shield Assume the outside of the goggles or face shield is contaminated: To remove, handle by head band or ear pieces Discard appropriately d) Respirator or surgical mask Assume the front of respirator / surgical mask is contaminated: Untie or break bottom ties, flowed by top ties or elastic and remove by handling ties only Discard disposable ones appropriately 24 November 2014 Donning and removal of PPE

18 Perform hand hygiene immediately after removing PPE. To minimise crosscontamination, the order outlined above should be applied even if not all items of PPE have been used. Clean hands thoroughly immediately after removing PPE. 24 November 2014 Donning and removal of PPE