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Visors and goggles (eye protection), headwear and footwear CHOOSING Goggles should protect you against splashes to your eyes. They should wrap around the eye area to ensure side areas are protected. Visors may be worn instead of a mask and goggle combination when there is a high risk of splattering or spray of blood or other body fluids. USING • Visors/goggles should be worn to protect the eyes whenever there is a risk of splashing to the face. They should be removed when no longer required. • Visors/goggles should be worn during aerosol generating procedures (intubation, oro/ nasopharyngeal suctioning, tracheostomy care, chest physiotherapy, bronchoscopy/ cardiopulmonary resuscitation). • Visors/goggles should be worn by all theatre staff directly participating in an invasive procedure where there is a risk of splashing to the face. • Torn or otherwise damaged face protection should not be used and should be removed immediately (safety permitting) if this occurs during

Masks CHOOSING • A wide range of masks are available: reusable and disposable surgical and FFP3 masks; masks with visors; masks without visors, etc. Make sure you know what is available in your place of work, how to wear it and how to use it – always follow the manufacturer’s guidance on use, make sure each item fits comfortably and check expiry dates. • If there is any possibility that blood, body fluids, medications or fluids of any type may be splashed in your face, you should wear a surgical mask. • If you are caring for someone with an infection that is transmitted via the airborne route, e.g. influenza, and will be performing an aerosol generating procedure such as intubation, oro/nasopharyngeal suctioning, tracheostomy care, chest physiotherapy, bronchoscopy/ CPR, etc., you should wear an FFP3 mask. • Manufacturers’ instructions should be adhered to while donning masks to ensure the most appropriate fit and optimum protection. USING The purpose of wearing a mask i

Aprons and gowns CHOOSING • Aprons and gowns should be water repellent and should allow you a full range of movement when worn and not interfere with your clinical activity. • Check expiry dates on sterile gowns before use – never use an out of date gown. USING • An apron or gown should be worn when contamination of your clothing or uniform might occur. • Disposable aprons and gowns are single-use items and should be disposed of via the clinical waste stream immediately after use. • Disposable, single-use plastic aprons should be worn when there is a risk of contact with blood/body fluids. • An impermeable gown should be worn rather than a plastic apron when there is a risk of significant splashing of body fluids, e.g. in an operating theatre or during invasive procedures. • Disposable long-sleeved gowns should be worn when caring for patients known or suspected to have scabies or any other parasitic skin infestation. • Colour-coded aprons and gowns are often worn for

Gloves CHOOSING Gloves are a medical device and should be treated as such: • Choose the right size to ensure a good fit in order to avoid friction, excessive sweating, finger and hand muscle fatigue and interference with dexterity. • Check the expiry date of the gloves you use – never use gloves that are out of date (glove material can deteriorate over time and an out of date glove might not perform as well). • Never use disposable latex gloves containing powder (due to the risks associated with aerosolisation and latex allergies). USING • Gloves should be donned before commencing a procedure where you might come into contact with blood/body fluids/chemicals/therapeutic creams/lotions and as required for the preparation of medications. • Gloves should be changed if they become punctured, damaged or torn, or if damage to the glove is suspected. • Two pairs of gloves should be worn (double gloving) during some exposure prone procedures (EPPs), e.g. orthopaedic and gynaec

Gloves, aprons, visors and masks – personal protective equipment (PPE) This section is broken down into smaller sections on general principles of PPE use – gloves, aprons and gowns, masks, visors and goggles, headwear and footwear – and a summary of when to use PPE is included. General principles The principles described here apply to all situations and all clinical settings. The term PPE refers to gloves, aprons, gowns, masks, goggles and visors. The appropriate use of PPE is essential for infection control. The benefit of wearing PPE is twofold in that it provides protection to both the wearer and the patient. Before donning PPE you should risk assess the situation – which items are most appropriate for the task/situation, depending on what you might be exposed to, e.g. blood/other body fluids? Not all items will be required each time. You should also consider sensitivities and the risk of latex allergy (your infection control team and occupational health department wi

Hand hygiene equipment SOAP AND WAT E R Plain liquid soap and water are adequate for hand washing for the majority of clinical care activities – the technique used to clean the hands is more important than the type of soap used. The six-step technique for hand washing is already discussed. It is also important that hands are washed under running water and not in static water, as the objective is to remove microorganisms from the hands and flush them down the drain; washing hands in static water, i.e. in a hand washbasin with a plug in, does not clean the hands as effectively as washing under running water. A N T I B A C T E R I A L S O A P S Antibacterial soaps are not required for general clinical activity; they are most useful in surgery due to their ability to lower the number of bacteria on the skin to a lower level than washing with plain soap would achieve, plus they have a residual effect, which means that it takes longer for the number of bacteria on the skin to re

Hand hygiene Washing the hands is the most effective way to prevent the spread of infection. This section is broken down into two subsections: the first covers when to wash the hands and the technique for doing so effectively; the second section discusses hand hygiene equipment, including soap, nailbrushes and hand washbasins. When and how to clean the hands WHEN Hands should be cleaned at the ‘five moments for hand hygiene’: 1. Before touching a patient. 2. Before a clean/aseptic procedure. 3. After exposure to blood/body fluids. 4. After touching a patient. 5. After touching a patient’s surroundings. More broadly speaking, this includes: • Before and after handling invasive devices (moments 1, 2 and 3). • Before and after dressing wounds (moments 1, 2 and 3). • Before and after contact with immunocompromised patients (moments 1 and 4). • After contact with equipment contaminated with blood/body fluid (moment 3). • After contact with blood/body fluid (moment 3). • A

Standard principles of infection prevention and control These principles were originally referred to as ‘universal precautions’ and are often referred to as ‘standard precautions’. To break the chain of infection the standard principles of infection control should be applied, which are: 1. Hand hygiene. 2. Correct use of personal protective equipment (gloves, aprons, visors and masks). 3. Control of the environment, which incorporates: °°decontamination (of healthcare equipment and the healthcare environment; management of blood and body fluid spillages); °°isolation and cohorting; °°respiratory hygiene; °°safe management of sharps and splash injuries; °°safe sharps practice; °°safe disposal of clinical waste; °°safe handling of linen and laundry. The aseptic non-touch technique is included here, as it is essential for infection prevention and control.

Whooping cough Whooping cough is a respiratory infection caused by the bacterium Bordetella pertussis. Whooping cough is a notifiable disease. SPREAD B Y Close direct contact with an infected person, by droplet spread. It is highly contagious – up to 90% of susceptible household contacts will develop the disease. I N F E C T I O U S P E R I OD The incubation period is usually 7–10 days (rarely it can be up to 21 days). The infectious period is up to 3 weeks after the onset of symptoms. Beyond 3 weeks, risk of transmission of infection is minimal, even if the cough persists. I N F E C T I O U S C O N T R O L P R E C A U T I O N S 1 Isolation Required 2 Hand washing Required 3 Gloves Required 4 Apron Required 5 Mask Required 6 Eye protection Not required The risk of transmission is minimal after 3 weeks of illness, but in a few cases (up to 20%) infectivity can persist for up to 6 weeks. Therefore the above infection control precautions should be taken in all hospitalis

Viral haemorrhagic fevers (VHFs) Viral haemorrhagic fevers (VHFs) are imported infections caused by a range of viruses. VHF infection is uncommon but is important because it is difficult to diagnose, has a high casefatality rate with no effective treatment and it can spread rapidly within the hospital setting unless correct precautions are taken. All units admitting returning travellers should have policies in place to risk assess and identify possible cases. Standard principles of infection control should be used while the assessment is carried out. Following the assessment, the patient is categorised as one of the following: highly unlikely to have VHF, possibility of VHF, high possibility of VHF or confirmed VHF. Further management, including the level of infection control precautions, depends on the outcome of the risk assessment. Always inform the Infection Prevention and Control Team and a consultant microbiologist of any suspected case of VHF. VHF is a notifiable dis

Typhoid A systemic infection with pronounced gastrointestinal symptoms, caused by infection with Salmonella typhi (also known as Salmonella enterica serovar typhi). Typhoid is a notifiable disease. SPREAD B Y The infection is present in the stools and sometimes in the blood and urine of an infected person. The commonest mode of spread is faecal–oral, usually through contaminated water (mainly in the developing world) or by contamination of food. Direct person-to-person faecal–oral transmission can occur in poor hygiene conditions or in men who have sex with men. Household transmission of infection may occur, probably through lapses in food hygiene. Most cases in the UK are acquired abroad. I N F E C T I O U S P E R I OD The incubation period is 7–14 days. Patients may remain infectious for several weeks after infection. Approximately 5% of cases become chronic carriers who continue to shed bacteria in the stool indefinitely. I N F E C T I O N C O N T R O L P R E C A U T

Stenotrophomonas Stenotrophomonas maltophilia is an environmental bacterium that may be found in hospitals and that can cause infections including respiratory tract infections, urinary tract infections, surgical site infections and bacteremia. It is intrinsically resistant to many antibiotics. Infections occur mainly in patients who are immunocompromised, have had a prolonged hospital stay, have had broad-spectrum antibiotics (particularly meropenem) or have been ventilated. SPREAD B Y Direct contact: transfer on hands from an environmental source. Indirect contact: transfer from equipment/environment. I N F E C T I O U S P E R I OD Stenotrophomonas is not readily transferred between patients provided standard principles of infection control are followed, but theoretically a patient may remain colonised and potentially infectious for months or years. I N F E C T I O N C O N T R O L P R E C A U T I O N S In a community setting or in a general ward, standard principles of i

Tuberculosis (TB) Infection is caused by the bacterium Mycobacterium tuberculosis. Respiratory TB is the commonest presentation, but TB can infect other body sites. Only respiratory TB is infectious. TB is a notifiable disease. SPREAD BY Droplet spread: patients with respiratory TB may expel droplets containing infectious TB bacteria into the air when they cough or sneeze. If these droplets are inhaled they can cause TB infection. Prolonged or close exposure is generally required to catch TB. I N F E C T I O U S P E R I OD The incubation period is variable: approximately 4–12 weeks from exposure to primary infection, though the disease may reactivate months or years later. A patient with infectious respiratory TB will remain infectious indefinitely if untreated. Patients are usually no longer infectious once they have completed 2 weeks of appropriate therapy. I N F E C T I O N C O N T R O L P R E C A U T I O N S Patients with known or suspected TB should not be admitted t

Toxoplasmosis A zoonotic (animal-transmitted) infection caused by infection with the parasite Toxoplasma gondii. Infection is more serious in pregnant women and immunocompromised patients. SPREAD B Y Contact with cat faeces, e.g. cleaning out cat litter trays. Ingesting water, food or soil contaminated with the faeces of infected animals, e.g. unwashed salad. Eating undercooked meat containing cysts. Vertical transmission from mother to foetus. Receiving an organ transplant from a donor with acute or latent toxoplasmosis. Direct person-to-person transmission does not occur, except from mother to foetus. See below for an explanation of the life-cycle and how transmission occurs. I N F E C T I O U S P E R I OD The incubation period is 5–20 days for acute infection. Reactivation of infection can occur years after the original exposure. There is no recognised infectious period because person-to-person transmission does not occur. I N F E C T I O N C O N T R O L P R E C A U T

Adhesins Microbial factors that enable bacteria to adhere to cells. Aerosol-generating procedure A procedure that can create an aerosol of the patient’s secretions, e.g. oro/nasopharyngeal suctioning, positive pressure ventilation, cardiopulmonary resuscitation, chest physiotherapy, bronchoscopy, creating droplets small and light enough to become airborne, increasing the possibility for transmission of infection to occur. Alcohol handrub An alcohol-based liquid, foam or gel for use on the hands to disinfect the skin. Alert organisms Organisms that can cause outbreaks of infection that are difficult to treat due to antibiotic resistance. Antibiogram A report that shows which of the antibiotics that are routinely tested will inhibit the growth of or kill the infectious agents they are tested on. Used to help make decisions about which antibiotics to use. Asepsis The freedom from contamination by pathogenic organisms. Aseptic technique A procedure or practice used to avoid