Infection Control Guidelines / Infection Control Guidelines

Infection Control Guidelines


The Scottish Government has set standards for Health Boards to achieve in preventing Healthcare Associated Infections (HAIs)1 and infection control teams are employed to help achieve and maintain these. Community pharmacies are not currently supported by NHS GGC infection control teams. However;

  • The 2009 pandemic influenza outbreak and a small survey of NHS GGC community pharmacies highlighted the need for more detailed infection control advice.
  • Although ‘Guidance for owners and superintendent pharmacists of pharmacy businesses’ from the General Pharmaceutical Council does not detail infection control, several standards require that they are safe and fit for purpose and they are subject to regulations detailed in the Health and Safety at Work Act 2.
  • Community pharmacies in NHS GGC offer clinical services including immunisation, near patient testing e.g. cholesterol and blood glucose testing.
  • Pharmacy staff can be exposed to accidental spillage of blood and body fluids during the course of routine business e.g. requests for first aid.
  • Pharmacists may be asked to provide diagnosis and treatment for potentially notifiable diseases e.g. measles.

Purpose of these guidelines

The purpose of these guidelines is to provide a minimum set of standards for Community Pharmacy contractors and their staff (CPs) to manage infection control risk during the normal course of business. Separate guidance is available which will be reviewed and issued in the event of a pandemic outbreak.

The recommendations draw from general principles of infection control and current recommended best practice e.g. management of ‘sharps’. They cover;

  • Premises
  • Planning and managing the pharmacy environment
  • Cleaning
  • Waste disposal
  • Hand washing facilities
  • Behaviours: Protecting staff and patients from infection.
  • Recognising and managing communicable disease
  • Resource guide, sources for staff training and references

Premises

• When fitting or re-fitting a pharmacy keep surfaces such as carpet, or soft furnished chairs to a minimum.
• Ensure areas used for ‘near patient’ testing are fitted with impervious surfaces which may be readily cleaned.
• Avoid ‘clutter’, file paperwork away and dispose of waste promptly, particularly in consultation rooms.

A virus can be transmitted by aerosolised particles when a patient vomits and subsequent vacuum cleaning of soft surfaces may spread infection by aerosolising the virus. Impermeable surfaces such as tiles or vinyl can be more readily cleaned and should be used particularly in areas of the community pharmacy used for ‘near patient’ testing, such as consultation rooms. These should ideally be fitted with ‘curved’ skirting boards between the floor and wall to prevent corners for dirt to accumulate and there should be a minimum of paperwork and documents stored in these areas.

Cleaning

• Have a regular cleaning rota undertaken by designated staff and clean areas that have been coughed or sneezed upon immediately
• Follow correct protocols when cleaning equipment used for near patient testing such as blood glucose monitoring equipment and smokelysers
• Pharmacies should have a blood spillage kit available.

Community pharmacies should have a regular cleaning rota and Standard Operating Procedures (SOPs) for cleaning in place. The rota and SOPs should ensure that clinical areas receive at least a once daily clean and cleaning tasks should be undertaken by specifically designated staff.
Most infectious organisms are readily killed by regular cleaning agents so cleaning with detergent i.e. commercially available cleaning agents will be sufficient in normal use, it is unnecessary to use specialist disinfecting agents. A guide to cleaning agents may be found here.
However, special care should be taken when cleaning surfaces infected by body fluids such as blood or vomit. The assumption must be made that these are always potentially infectious. Further details are available in Appendix 3.


Waste Disposal

• Paper towels for hand drying and used tissues should be disposed of in a foot operated, lidded and lined pedal bin.
• Pharmacies should not accept ‘sharps’ for disposal unless they are ‘Injection Equipment Providers’ (IEPs).
• Returned medicines and ‘sharps’ should be promptly disposed of in an appropriate container.
• Sharps containers must be, assembled correctly, filled no more than 2/3 full, closed securely and returned for incineration to an appropriate carrier (IEPs should use a designated NHS GG&C carrier).
• All used packaging material and other refuse should be promptly removed from business areas and stored appropriately for regular uplift by waste disposal services.

Hand Washing Facilities

• A sink with warm running water should be available for hand washing in all clinical areas e.g. dispensary, consultation room.
• Hand washing facilities should be readily available for all front shop staff.
• Paper towels, liquid soap and lidded, lined foot operated pedal bin should be available at all sinks designated for hand washing.
• The current hand washing guide should be prominently displayed at all sinks designated for hand washing.
• A separate sink should be available for the management of clinical samples.

If possible a sink should be designated for hand washing only. Liquid soap dispensers filled with disposable soap pouches and paper towel dispensers should be fitted to the wall at the sink.

Behaviours: Protecting staff and patients from infection

• All staff should receive training in hand washing and should be encouraged to wash their hands frequently.
• Hand washing should always be undertaken before and after patient contact.
• Staff should understand and be able to demonstrate ‘cough etiquette’
• All staff working in pharmacies who are ‘injecting equipment suppliers’ or who are involved with finger prick testing and vaccination procedures should receive immunisation against Hepatitis B infection.
• All staff should receive education on the management of needle stick injuries.
• The pharmacy should have SOPs in place for the management of patient returned medicines,
• Pharmacies should not accept returned ‘sharps’ unless they are ‘injecting equipment suppliers’ who should have appropriate SOPs in place.
• Community pharmacies offering vaccination and ‘near patient’ testing must follow recommended infection control protocols for these activities.
• Staff should follow basic infection control techniques when offering first aid e.g. wearing gloves to dress a wound when possible.

Many common viruses and infections are spread by hand to mouth contact so encouraging regular hand washing is a good cost effective way to prevent staff succumbing to infections they might be exposed to in the pharmacy such as influenza. A hand washing guide is available here
Staff who clearly may be routinely exposed to needle stick injury should be vaccinated against Hepatitis B. This protects both them and their patients.
Consideration should be given to offering this to all staff in the pharmacy, especially those who may be involved in accepting returned patient medicines, as there have been incidents of needle stick injury with returned lancets in bags of returned medicines. SOPs should detail ways of minimising this occurrence.
Personal Protective Equipment (PPE) such as gloves should be worn when undertaking finger prick testing and administering first aid when possible. A description of types of PPE may be found here.  In general it is not necessary to use face masks in community pharmacy.

Recognising and managing communicable disease

• All patients presenting to community pharmacy suspected of having a notifiable illness or communicable disease should be referred to their GP.
• All patients presenting to community pharmacy with symptoms of a communicable disease should be counselled on preventing disease spread appropriately.
• Community pharmacy staff should be aware of the NHS GG&C Primary Care Infection Management guidelines and counsel on appropriate antibiotic use.

Patients suspected of suffering a notifiable illness such as meningitis, measles, mumps or rubella should be referred to their GP promptly so they can report the illness to the public health protection team who will advise on any required treatment for close family members and contact tracing. Notifiable diseases are listed in Appendix 1 to the ‘Implementation Guidance for Public Health etc Scotland (2008) Act’


Resources and sources for staff training

Hand washing and cough etiquette
Health Protection Scotland (HPS) hosts a site dedicated to hand washing and hand washing promotional material.

NHS GG&C Infection Control team have a hand washing site with a the poster ‘6 Steps for Hand Hygiene’


Hand Hygiene National Health Education Scotland (NES)

Infection Prevention and Control Guidelines for NHS and non- NHS Community and Primary Care settings has useful information and a guide to ‘cough etiquette’.

Antimicrobial use and Infectious diseases


NHS GGC Primary Care Adult Infection Management Guidelines

NHS GGC Primary Care Paediatric Infection Management Guidelines

NES provide courses on Antimicrobial Use, Influenza (Pandemic), Responding to Minor Ailments

• A list of notifiable diseases may be found in the ‘Implementation Guidance for Public Health etc Scotland (2008) Act.  This list is subject to change.

 
HPS toolkit for managing norovirus outbreak. The toolkit is for use in the acute setting but contains some useful advice which may be extrapolated to other healthcare settings.

Norovirus leaflet for patient use


Managing needle stick injury

Management of Occupational and non Occupational Exposures to Bloodborne Viruses NHS GGC 

Managing the environment for vaccination procedures
The NHS GGC ‘Immunisation Resource Pack’ gives details on how an area used for vaccination should be prepared

Self audit Tool
• A self audit tool is available as part of the NHS GGC Community Pharmacy Clinical Governance Audit teams suite of self audit modules on the Community Pharmacy Development Team website.


References

1. Healthcare Associated Infection Standards Report, NHS QIS, August 2008

2. The Health and Safety at Work Executive. General information on the Health and Safety at Work Act.


3. Infection Prevention and Control Guidelines for NHS and non- NHS Community and Primary Care
    settings 

4. Pandemic Flu; Guidance for Businesses, Department of Health March 2009

 5. General information and infection control precautions to minimise transmission of Respiratory Tract Infections (RTIs) in the healthcare setting.


6. ‘Dealing with accidents in the pharmacy’ Pharmaceutical Journal, 2011;286:69-70.

If you have any questions about these guidelines please contact the Public Health Protection Pharmacist on 0141 201 4824.

Acknowledgement
We would like to acknowledge the help of Mr Vincent McKeown, Health Protection Nurse Specialist, NHS GGC Public Health protection Unit in preparing these guidelines.