Implementing Infection Control in Your Clinic

Infection control and control of substances hazardous to health (COSHH) go hand in hand. We use COSHH in our daily life, however, we tend not to call it that. When we use bleach or washing-up liquid at home, these are all classed as hazardous to health, and we need to be mindful of how we use them. In your clinic this is essential to ensure you are following COSHH guidelines and have the correct protocols in place. Many substances used for cleaning your clinic will come under COSHH, hence the link to infection control.

Infection prevention is imperative in a clinic setting. Being aware of what makes a good cleaning regimen and how to manage COSHH is essential, so it doesn’t become burdensome. Having staff on board and trained ensures a good clinical environment with a reduced risk of infection. With COVID-19 measures slowly diminishing, this article aims to ensure that infection control measures are still upheld whilst providing tips that can help to ensure that you are using the best practice in your clinic. Infection control is an ongoing process and clinics need to maintain standard precautions daily. These are good hand hygiene, use of personal protective equipment (PPE) and respiratory hygiene/cough etiquette in healthcare settings.

Areas of infection

It’s important to think about the premises from the front door to the back offices. Think about the patient and staff journey as staff can transmit infection from the back office to the front desk as well as any additional areas they walk around. An interesting exercise is to place post-it notes on each surface you touch without even thinking about it. This can be conducted during training or when undertaking an audit.

Standard infection control precautions, formerly known as universal precautions, underpin routine best practice, protecting both staff and patients from micro-organisms that may cause infection.¹

Key areas to focus on in your clinic are:

• Hand hygiene
• PPE such as protective glasses or masks. These can be determined by the treatment being undertaken
• Disposal of sharps and waste
• Decontamination of equipment
• Single use equipment

Ask yourself what you are implementing in each area. Are you undertaking audits consistently? Audits are different for each clinic as it is dependent on the size of the clinic. In my view, an audit is a quality assurance tool for you to see if best practice is being followed and that written procedures are mirrored in working practice. It’s all very well training staff, however it is just as important to check competency and adherence. Findings from audits should be discussed among the team and checked for any areas that need improving. When undertaking routine tasks, it can be easy to forget a step. Implementing standard operating procedures when undertaking treatments is good practice as in the circumstances of something going wrong, you can check this against the process. It might not be much, but if there are a chain of errors then the potential for something catastrophic to happen is increased.

The Infection Prevention Society (IPS) has some useful resources and audits which can be adapted, meaning you do not have to start from scratch but can change it to the needs of your organisation.²

Hand hygiene

All staff should have training on hand hygiene and posters should be up by sinks on the necessary hand washing methods. Hand hygiene audits should be undertaken annually. This should involve observations to ensure that the correct technique is being used by all staff.³ The key areas to look at include the five moments of hand hygiene, which include before patient contact, before a clean/aseptic procedure, after body fluid exposure risk, after patient contact and after contact with patient surroundings.³

PPE

The PPE used in-clinic needs to be fit for purpose and you should conduct regular audits to ensure that staff are using PPE correctly for their own safety and their patients.² The current legislation which refers to the supply of personal protective equipment is the Personal Protective Equipment Regulations 2016/425, which is enforced by the Personal Protective Equipment (Enforcement) Regulations 2018.⁴ By using the correct PPE and disposing of it correctly reduces the likelihood of infection being spread from one area of the clinic to another.

Safe handling and disposal of sharps

Effective management of sharps comes from the Health and Safety (Sharp Instruments in Healthcare) Regulations 2013.⁵ Each employer should do a risk assessment on the sharps used and ensure that staff are adequately trained. Sharps need to be disposed of appropriately into designated sharps bins. Sharps bins need to be specifically sourced for sharps and must have a contract to be collected by an appropriate waste management company after they have reached the max line. The areas I have seen errors in when disposing of sharps has been no label on a sharps bin, the wrong size sharps bin for the area and placement of sharps bin in an unsafe manner.

Britain’s national regulator for workplace health and safety, The Health and Safety Executive, states, ‘Regulation of COSHH requires systems to dispose of contaminated waste safely. The sharps regulation supplement this by requiring that clearly marked and secure containers are placed close to the areas where medical sharps are used. Instructions for staff on safe disposal of sharps must also be placed in those areas’.⁵

Safe handling and disposal of waste

The management of healthcare waste is essential to reduce the risk of infection, however, it is also regulatory. The ‘Health Technical Memorandum Management and disposal of healthcare waste’ gives guidance on the best practice for waste management and top tips which aesthetic practitioners can learn from such as the correct type of bins for the appropriate sharps you use, the right colour bags for clinical waste and general waste, ways to improve the environment and carbon impacts of managing waste.⁶ Be aware of your responsibilities as a waste producer.

Although it is not mandatory, here is a useful colour coding system which is used in England, Wales and Northern Ireland, and I believe it’s a good idea to implement it. When staff move from one employer or location to another, they will understand the system and consistency can be maintained. It is also good for the environment to have the waste segregated correctly. Storage of the waste whilst awaiting collection is important and must be done in a safe manner.

The colour coded system for waste is:

• Orange – clinical and infectious waste
• Blue – medicinal waste
• White – dental amalgam waste
• Yellow – clinical and highly infectious waste
• Red – anatomical waste
• Tiger – offensive/hygiene waste
• Purple – cytotoxic and cytostatic waste
• Black – mixed municipal waste

Decontamination of equipment and single use equipment

Personally, I believe it is advisable where practicable to use single use items. However, when decontamination is required, it needs to be undertaken under proper environmental control, which is dependant on each clinic’s set up.⁷ Clean and dirty areas must be separated, thereby reducing the likelihood of cross contamination. Staff using the decontamination equipment must be trained on using it and each manufacturer will train staff differently based on their protocols. Good practice in this area reduces the likelihood of the spread of infection.

There are three levels of decontamination, which include: general cleaning, disinfection, and sterilisation. Equipment used in healthcare settings may be designated as single use, single patient use or reusable multi-patient use. The likelihood of contamination and infection risk will depend on the contamination. Each clinic should do a risk assessment, so they know what level of decontamination, if any, is required.⁸

Cleanliness is key

Managing the chemicals and hazardous waste is important. The NHS have a colour coding system for cleaning, which, if you use in your clinic, will ensure that the cleaner attending the workplace can help to reduce infection too.⁹

The colour coding system is:

• Red – bathrooms, washrooms, toilets, basins and bathroom floors
• Blue – general areas including wards, departments, offices and basins in public areas
• Green – catering departments, ward kitchen areas and patient food service
• Yellow – isolation areas

It is to be found in the national standards of healthcare cleanliness.⁹ When using a cleaning company check if they are a member of the British Institute of Cleaning Science or the British Cleaners Association. This is a positive as it will mean they have specific requirements to meet.^10,11

The ‘National Standards of Healthcare Cleanliness 2021: Health and Safety’ is a place to start.¹² It provides a good understanding of what cleanliness is in a healthcare setting and covers auditing as well. If you aren’t already auditing, you won’t be aware of where improvements can be made.

Have an infection-free clinic

Infection control is imperative in a healthcare setting of any capacity. By using these recommendations and aligning them to the size of your clinic, you will be able to make it a safe place for your patients and staff whilst meeting good practice as well as any statutory standards you need to meet as a clinic.