Infection Prevention and Control Annual Statement

2024

Cambridge Avenue and Messingham Medical Centre

In accordance with The Health and Social Care Act 2008 Code of Practice this statement will be reviewed annually. It includes details of –

• Significant events including transmission of infection incidents and action taken
• Infection control audits carried out and actions taken
• Staff Training
• Review and up-dates of policies, procedures and guidelines

Infection Prevention and Control (IPC) Lead

Bryony Toyne – Practice Nurse.

Bryony attends quarterly meetings organised by the CCG to ensure high quality IPC monitoring is carried out through the surgery. She joined the practice in September 2024 and has valuable IPC knowledge due to working in a range of clinical environments.

The IPC role has been supported by Kay Fowler – Practice Manager and Louise Trought – Deputy Manager. Both Kay and Louise started working at the practice recently. All three value the importance of providing staff and patients with a clean and safe environment.

Significant Events

A significant event is any unintended or unexpected event which can lead to harm of staff member or patient. This can also be in the form of infection transmission incidents. It is important to review and action on significant events to promote a safe clinical environment and good practice. All significant events are discussed at staff meetings and learning events are formulated to avoid reoccurrence. No significant events have happened this year.

Infection Prevention Audits and Actions

The Annual Infection Control Audit was completed before Bryony started at the practice by Nurse Associate Emma in July 2024.

The findings and actions from this audit include –

• Clinical rooms in the older part of the building (6,7,8,9,10,11,12,14,15,16) do not comply with HBN 00-10 Part C guidance as they all have an overflow compartment. It has been agreed with the IPC Lead that this can be rectified over a longer period due to cost implications.
• Clinical Rooms (6,7,8,9,10,11,12,14,15,16) do not have Dani-centres. Therefore, gloves are being stored on work surfaces. This results in unnecessary clutter and difficulty cleaning thoroughly. New Dani-centres have been ordered for these rooms.
• The couches in clinical rooms 5, 7 and 16 have tears in them. These beds with be disposed of and replaced.
• There was non-wipeable charrs in the reception, admin and clinical rooms. All these chairs have been discarded and every chair is now wipeable.
• Bins including clinical and general waste were visibly dirty. A cleaning rota has been formulated to ensure bins are cleaned regularly. The bins in disrepair have been replaced.
• Steps used for clinical room couches were visibly dirty. These have been placed on a cleaning rota or disposed of if in disrepair.
• No process for ensuring clinical rooms have been cleaned. A cleaning rota has been formulated which will be visible to patients in the clinical rooms and toilets.
• No evidence of staff completing aseptic non touch technique training. Bryony has the facilities to train all staff in this area and staff can complete an online training module. We also have a ‘glow box’ which is used on a regular basis to help staff members understand correct hand washing technique. We have posters at all sinks to remind staff and patients how to do this correctly.

The Cambridge Avenue and Messingham Medical Centre Completed Audits in 2024 include –

• Annual Infection Prevention and Control Audit
• Annual Review of Functional Risk Categories
• Annual Aseptic Non-Touch Technique
• Weekly Safe Use of Equipment Audit
• Monthly Safe Use of Equipment Audit
• Monthly Hand Hygiene Audit
• Monthly Vaccine Fridge Audit
• Quarterly Sharps Bins Audit
• Quarterly Personal Protective Equipment Audit

Risk Assessments

Risk Assessments are carried out annually. The ongoing risk assessments are as followed –

Legionella (water) Risk Assessment: We are following the correct procedures in ensuring safe use of water at the practice. It is crucial that we provide safe water to staff and our patients. Last reviewed: October 2024

Immunisations: As a practice we encourage staff to have their yearly Flu and Covid Boosters. All clinical staff are offered their occupational health vaccinations applicable to their role- these include MMR and Hepatitis B. We carry out a lot of Covid and Flu clinics at the practice to keep up with the National Immunisations Campaign for patients and offer vaccinations in house, such as PPV, Shingles and RSV to patients who are eligible.

Curtains: At the practice we use disposable curtains, according to the NHS Cleaning Specification disposable curtains should be changed every 6-12 months or when visibly dirty. The curtains are regularly reviewed and were all changed in September 2024. We do not have blinds or curtains in the clinical rooms as shutters are in place, the windows are low risk but do need regular cleaning to prevent the build up of dust or debris.

Cleaning frequencies: Bryony reviews each room and its functional risk category in line with the Care Quality Commission (CQC) Guidance. This ensures each room in the practice if cleaned at an appropriate time frame. For example, treatment rooms/minor operations rooms are cleaned more thoroughly and frequently than the admin offices. Louise and Bryony have formulated a new cleaning schedule that includes the functional risk categories to ensure we are performing in accordance with the guidance. This will be reviewed annually.

Hand washing: The practice has clinical hand washing sinks for all staff to use. Bryony completes a monthly audit on all clinical and non-clinical staff. It is a requirement for everyone to be audited at least annually.

Training

Bryony is going to introduce IPC to every staff meeting to ensure they are aware of audits and their outcomes. All staff have access to IPC training online and are required to updated this annually. The IPC should attend quarterly IPC meetings organised by the CCG and lead by the Nurse Lead for IPC in Primary Care.

Sarah Coult the current Nurse Lead is stepping down from her role in November. We are awaiting confirmation of the new Lead.

Policies

IPC policies and procedures are available to all staff electronically. Harrogate IPC share monthly bulletins and updated us on any changes to current advice, guidance or legislation. These are circulated to all staff and discussed at meetings when necessary.

Responsibility

All staff have a responsibility to be familiar with this statement and their roles in infection prevention and control.

Responsibility to review

It is the responsibility of IPC Nurse to update the IPC statement annually. This is currently Bryony Toyne - Practice Nurse.

Date published: 29.10.2024
Date last updated: 29.10.2024