Journal of Perioperative Practice PROCUREMENT GUIDE July 2013

Journal of Perioperative Practice

PROCUREMENT GUIDE July/August 2013 Volume 02 Issue 03 01423 881300 www.afpp.org.uk

01423 881300 www.afpp.org.uk

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Contents

Welcome to your July/ August 2013 Guide 05

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Infection control

Infection prevention product solutions: support for practice at critical points in care

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Correct equipment draping is essential to reduce infection risk Visitors to the perioperative environment

Hand hygiene

Eye of the Needle AfPP Theatre Access Course

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Theatre attire

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Guide to best practice for safe handling of surgical sharps

Journal of Perioperative Practice Procurement Guide information In print within the AfPP Journal of Perioperative Practice covering national AfPP members, but also with a dedicated print and e-distribution to supplies and purchasing managers.

Key Sectors: NHS Supply Chain, Independent Hospitals, Higher Education. Medical Device Companies.

Published 6 times a year we will focus on procurement issues in every edition as well as specialist subjects which for the following year include:

September 2013 Airway management November 2013 Safety January 2014 Recovery

Contact Information: Advertising, Sponsorship & Partner Packages.

Frances Murphy Account Manager Open Box M&C T: 0121 200 7820 E: francesmurphy60@yahoo.com Editorial Chris Wiles Head of Publishing / Editorial AfPP T: 01423 882950 E: chris.wiles@afpp.org.uk

PR & press material.

All press releases welcome and we will feature as many as we can in each issue, all press releases need to be submitted to: Frances Murphy Account Manager Open Box M&C T: 0121 200 7820 E: francesmurphy60@yahoo.com

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Infection Control

Infection control One of the top priorities within the NHS is to provide the highest standards of healthcare to patients and to continually improve the patient experience. Infection prevention and control is a national priority and has recently come under the media spotlight. Infection control is a practical approach to addressing factors relating to the spread of infections within the healthcare setting, from patients to staff and from staff to patients.

Infection control is the discipline concerned with preventing healthcare-associated infection (HCAIs). A significant amount of HCAIs are preventable by using effective infection prevention and control methods. Infection prevention and control can be summarised as follows: •

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All activities designed to either prevent or control infection It relates to any environment but is particularly important to healthcare settings It includes direct care i.e. hand hygiene, management of intravascular devices It includes indirect care i.e. sterlisation of medical devices, cleaning of the environment

Healthcare Associated Infections can be defined as: ‘Any infection by an infectious agent acquired as a consequence of a person’s treatment by the NHS (or other healthcare provider), or which is acquired by a healthcare worker as a result of their duties’.

Health Act 2006 (updated 11 January 2008) Four key considerations why HCAIs are important to an organisation are: 1. Quality One of the underlying premises of healthcare is to do no harm, even if you can’t do any good. HCAIs increase patient suffering

and increase the likelihood of poor outcomes, even death.

2. Cost Treating HCAIs costs money that would not otherwise be necessary i.e. antibiotics, dressings, IV Cannulae, treating long term problems caused by infection 3. Legal HCAIs can result in litigation which in turn can affect the organisations insurance policies as well as having a detrimental effect on their reputation.

4. Throughput Patients with HCAIs stay in hospital 2.5 days longer than similar patients without infection.

Responsibilities

Responsibilities can differ from one organisation to another; however, generally the registered manager at the treatment centre is responsible for ensuring that effective measures are in place for infection prevention and control. Each treatment centre should have a dedicated infection control team with supporting policies and procedures. Risk assessments and audits should take place on a regular basis to ensure sufficient funding is available to support good practice.

Hand hygiene

Hand hygiene is the single most effective method of preventing cross infection. Hand washing with soap and water should

Responsibilities can differ from one organisation to another; however, generally the registered manager at the treatment centre is responsible for ensuring that effective measures are in place for infection prevention and control. Risk assessments and audits should take place on a regular basis to ensure sufficient funding is available to support good practice.

be done within each of the following situations: • Before starting work and before leaving each work area • After using the lavatory, blowing your nose or covering a sneeze • Whenever your hands are obviously dirty or after handling a soiled item • Before eating, drinking or handling food • After removing items of protective clothing such as aprons or gloves.

Personal protective equipment (PPE)

Personal protective clothing should be worn if you are going to carry out a procedure which may involve exposure to splashes of blood or bodily fluids.

Protective clothing provides a physical barrier to infection.

Each individual is responsible for their own actions and ensuring they comply with infection control policies and procedures.

Dawn L Stott Chief Execuitive, AfPP References Association for Perioperative Practice Infection Control – Online Education www.afpp.org. uk/careers/online-education Infection Prevention Society www.ips.uk.net National Institute for Health and Care Excellence Infection control (CG139) Prevention and control of healthcare-associated infections in primary and community care [online] Available from: www.nice.org.uk/CG139 [Accessed June 2013]

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Infection Control

Infection prevention product solutions: support for practice at critical points in care

and other national guidance (DH 2006, NICE 2008a, NICE 2008b, DH 2008a,b):

The role of partnerships to strengthen effective solutions

Implementation of a Care Bundle is multifaceted and can be challenging, influenced by a number of factors: •

Infections have long posed a serious risk to our health and well being. As we approach an era where antibiotics potentially cannot offer the protection long taken for granted (DH 2013) the importance of infection prevention practice and associated research is a priority.

To contextualise the scale of the problem, more people die of infection than do from prostate, bowel and breast cancer combined in one year (Sepsis UK).

Healthcare associated infection (HCAI) is a significant group of infections that are essentially an adverse outcome for patients. It is thought that 30-50% of these could be avoided by utilising and implementing practice that we know can make a difference (National Audit Office 2000, Plowman et al 1999, Plowman et al 2001). The 2011 prevalence survey in England identified that 6.8 % of patients acquire an infection whilst in hospital. Of these, 15.7% are surgical site infections (HPA 2011).

It is imperative that we constantly review our approach to reducing this risk in healthcare and, as part of that, reflect on the interaction between all sectors that contribute to this agenda.

Surgical site infection (SSI)

Five percent of all patients undergoing a surgical procedure develop an infection. There are important elements of care that must be followed to reduce the risk of SSI a ‘Care Bundle’, an approach that has become increasingly widespread in the UK (DH 2011, HPS 2012) Figure 1 (below) sets out the SSI Care Bundle that reflects crucial elements of clinical care, and supported by NICE guidance

Involvement of clinical staff as users and evaluators is crucial in ensuring the correct resource is developed and fit for purpose. Clinical staff play a vital role in choice of product and in new product design and development.

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Staff knowledge and putting knowledge into action requiring investment in staff development and training Usable devices and technologies vital to support the implementation of our knowledge base in practice, and this incorporates both design and human factors.

At every step of the Care Bundle there is a product or technology that facilitates success or a solution to achieve that intervention. In practice, this relates to a minimum of 14 products for the SSI Care Bundle, ranging from simple to highly developed technologies. It is an intricate mix of IT systems, product and clinical care, used in synergy that results in our ability to deliver all elements of the SSI Care Bundle.

Engagement and involvement of clinical staff as users and evaluators is crucial in ensuring the correct resource is developed and fit for purpose.

Clinical staff play a vital role in choice of product and in new product design and development, shaping the future not just alongside but working in partnership with industry.

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Relationships

Close working between and good relationships with industry and healthcare providers remain as relevant as they have always been. To adapt and respond to future requirements in healthcare, consideration of partnerships must be central to a joined up approach: Industry must be able to identify its position in Infection Prevention and be able to demonstrate and evaluate the level of impact its input has to reducing HCAI. The plan to establish a NHS Life Sciences Innovation Delivery Board (DH 2009) supports a progressive relationship between industry and healthcare. Similarly the Infection Prevention Society has incorporated an objective of reviewing its relationship with industry into its 2013 business plan (IPS 2013). These opportunities, if embraced will provide a rich mix of clinical knowledge and skill that can be fully engaged in shaping our ability to ensure excellent infection prevention practice is the standard of care and treatment that all patients are assured of, at all times and throughout any healthcare experience they may have.

Companies that manufacture products to support core Care Bundles, where we know the impact of practice can make a difference to patient outcomes, must be viewed as central to the ability to achieve compliance with evidence. The integration of industry solutions into healthcare is thus a logical part of the Care Bundle approach with an emphasis on user engagement.

Kathryn Topley Clinical Efficiency Manager, Infection Prevention Division, 3M References Department of Health 2006 Screening for MRSA colonisation: a summary of best practice Professional Letter from the Chief Medical Officer and the Chief Nursing Officer London, DH Available from: http:// webarchive.nationalarchives. gov.uk/20080906005344/ http://dh.gov.uk/en/ Publicationsandstatistics/

Infection Control Lettersandcirculars/ Professionalletters/ Chiefmedicalofficerletters/ DH_063138 [Accessed June 2013] Department of Health 2008a MRSA screening – operational guidance London, DH Available from: http:// webarchive.nationalarchives. gov.uk/20130107105354/ www.dh.gov.uk/en/ Publicationsandstatistics/ Lettersandcirculars/ Dearcolleagueletters/DH_086687 [Accessed June 2013] Department of Health 2008b MRSA screening – operational guidance 2 London, DH Available from: http:// webarchive.nationalarchives. gov.uk/20130107105354/ http://www.dh.gov.uk/en/ Publicationsandstatistics/ Lettersandcirculars/ Dearcolleagueletters/DH_092844 [Accessed June 2013] Department of Health 2009 NHS 2010–2015: from good to great.

Preventative, people-centred, productive [online] Available from: http://www.gmcvo.org.uk/ node/1837 [Accessed June 2013] Department of Health 2011 Clean Safe Care Available from: http:// webarchive.nationalarchives.gov. uk/20120118164404/hcai.dh.gov. uk/ [Accessed June 2013] Department of Health 2013 Annual Report 2011 of the Chief Medical Officer Volume 2 [online] Available from: https://www.gov. uk/government/publications/ chief-medical-officer-annualreport-volume-2 [Accessed June 2013] Health Protection Agency 2011 English National Point Prevalence Survey on Healthcare-associated Infections and Antimicrobial Use [online] Available from http:// www.hpa.org.uk/Publications/ InfectiousDiseases/Antimicrobial AndHealthcareAssociated Infections/1205HCAIEnglishPPS forhcaiandamu2011prelim [Accessed June 2013] Health Protection Scotland 2012 Targeted literature review: What are the key infection prevention

and control recommendations to inform a surgical site infection (SSI) prevention quality improvement tool? Part of HAI Delivery Plan 2011-2012: Task 6.1: Review of existing infection prevention and control quality improvement tools to ensure ongoing need and fitness for purpose Glasgow, HPS Infection Prevention Society 2013 IPS Board Business Plan Available from: http://www.ips. uk.net [Accessed June 2013] National Institute for Health and Care Excellence 2008 Surgical Site Infection (CG74) Prevention and treatment of surgical site infection [online] Available from: http://www.nice.org.uk/CG74 [Accessed June 2013] National Institute for Health and Care Excellence 2008 Perioperative Hypothermia Inadvertent (CG65) Management of inadvertent hypothermia in adults [online] Available from: http://www.nice.org.uk/CG65 [Accessed June 2013] National Audit Office 2000 The management and control of hospital acquired infection in acute NHS trusts in England London, The Stationery Office Plowman R, Graves N, Griffin M et al 1999 The socio-economic burden of hospital acquired infection London, Public Health Laboratory Service Plowman R, Graves N, Griffin M et al 2001 The rate and cost of hospital acquired infections occurring in patients admitted to selected specialties of a district general hospital in England and the national burden imposed Journal of Hospital Infection 47 (3) 198-209 The UK Sepsis Trust http:// sepsistrust.org

Healthcare associated infection (HCAI) is a significant group of infections that are essentially an adverse outcome for patients. It is thought that 3050% of these could be avoided by implementing practice that we know can make a difference. The 2011 prevalence survey in England identified that 6.8 % of patients acquire an infection whilst in hospital.

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Infection Control

Correct equipment draping is essential to reduce infection risk Equipment drapes are now widely used in surgery but ensuring that the right drape is used is essential to minimise the risk of infection.

Available through NHSSC, Ecolab’s Microtek range is the most extensive from a single supplier. Working in tandem with Equipment Manufacturers, Ecolab are able to tailor their drapes to the latest developments, ensuring that they will fit correctly from the start.

This ‘fit for purpose’ approach is not exclusive to new innovations either - all Microtek products are designed with the particular piece they are covering in mind.

The extensive product range is enhanced by Ecolab’s excellent training for theatre personnel on how to fit the right product to the right piece of equipment, especially important on more complex items such

Visitors to the perioperative environment People are the main source of infection; therefore the number of visitors to the theatre environment should be restricted. Theatre facilities must provide guidelines and policies for visitors entering the theatre environment which should take into account infection control standards and practices and restrictions on traffic in the theatre environment.

If visitors actually enter the operating theatre itself, then theatre attire for that environment should be worn.

Medical device representatives

There are implications for the

medical device representative, medical staff and the hospital, that must be addressed prior to admission being granted.

These implications include patient consent, medical indemnity, confidentiality, health screening and the role of the representative within the perioperative environment.

The theatre manager or designated deputy must undertake a risk assessment of visitors such as a medical device representative in accordance with the Health and Safety at Work Act 1974 and the Management of Health and Safety at Work Regulations 1992. These regulations state:

as microscopes and C-Arms.

This training is delivered either directly by the team of Microtek Healthcare Managers or can be conveniently viewed on a series of ‘How to’ videos produced by the company. Comprehensive leaflets and charts are available as well.

every day, they are constantly improving draping methods. For example, one of our Healthcare Managers recently developed a new technique for microscope draping which was welcomed as an improvement on the existing technique.”

Ecolab’s Surgical Sales Manager, Tim Eaglen, says: “Our strong relationship with the equipment manufacturers means we are able to develop ideal draping solutions for our customers. This significantly reduces the risk of cross-contamination caused by exposed equipment through badly fitted drapes.”

In addition to the reduction in potential contamination, well fitted drapes protect the valuable equipment used in theatre, providing a compelling financial case for the budget-conscious theatre manager.

He continues: “Also, because our teams are out in the field

‘Every employer shall make a suitable and sufficient assessment of the risk to health and safety of persons not in his employment, arising out of or in connection with the conduct by him or his undertakings.’

The risks involved with the visit should be assessed prior to the visit and the companies made aware of the potential risks involved. The following guidelines should be followed: •

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Medical device companies have a duty of care to provide the theatre manager with an appropriate risk assessment for the purpose and practicalities of the visit, including any medical devices or equipment to be brought in. This will include informing the theatre manager if the medical device representative is an expectant mother.

Medical device representatives may act only as a resource regarding the representative’s product, and may not scrub or actively

Free trials of selected equipment drapes or training on drape fittings, can be arranged by calling 0113 232 2480 or emailing alison. waite@ecolab.com

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participate in patient care.

Medical device representatives should have attained a validated professional award in access to the operating theatre before being permitted access to the perioperative environment; such as those endorsed by The Association for Perioperative Practice (AfPP).

Demonstrations of new technology should take place in a workshop or laboratory setting, and perioperative staff should be familiar with the technology prior to direct patient use.

The operating surgeon must notify the theatre manager of the date, time and procedure where a medical device representative has requested to attend.

Reference Association for Perioperative Practice 2011 Standards and Recommendations for Safe Perioperative Practice (3rd ed) Harrogate, AfPP

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Infection Control

Hand hygiene Infection prevention and control is never far from the minds of practitioners who work within the perioperative environment, and it informs many of the daily procedures and practices within healthcare.

It has been well documented that effective hand hygiene is one of the biggest preventative measures healthcare professionals can take in relation to reducing the spread of infection (Aziz 2013).

In 2009 the World Health Organisation (WHO), as part of their global campaign ‘Save Lives: Clean your hands’, recommended the use of a strategy to raise awareness regarding the importance of hand hygiene in combating hospital acquired infections.

The five ‘key moments’ of hand hygiene was aimed to improve compliance by all those responsible for patient care. Recently, the WHO (2013) has encouraged us to continue to monitor hand hygiene and provide feedback to staff within our departments and celebrate success. In theatre, it is natural for us to focus on surgical hand asepsis however, we should not neglect good hand hygiene principles.

Within Standards and recommendations for safe perioperative practice (2011) AfPP recommend the same systematic method for hand decontamination for both surgical antisepsis and a social hand wash.

According to the WHO ‘Clean Care is Safer Care’ programme, when working with patients, hand hygiene should be performed at 5 key moments, preferably by using an alcoholbased rub or by hand washing with soap and water if hands are visibly dirty. The five moments for hand hygiene are: • •

• • •

before touching a patient before clean and aseptic procedures (e.g. inserting devices such as catheters) after contact with body fluids after touching a patient after touching patient surroundings.

If you are a visitor to the perioperative environment it is also important that you are

Recently, the WHO (2013) has encouraged us to continue to monitor hand hygiene and provide feedback to staff within our departments and celebrate success.

In theatre, it is natural for us to focus on surgical hand asepsis however, we should not neglect good hand hygiene principles.

aware of the procedure to carry out an effective hand wash for both your own protection and the protection of others.

Ruth Collins Trustee (AfPP) Association for Perioperative Practice 2011 Standards and Recommendations for Safe Perioperative Practice (3rd ed) Harrogate, AfPP 193-195 Aziz AM 2013 How better availability of materials improved hand hygiene compliance British Journal of Nursing 22 (8) 458-63 World Health Organisation 2013 WHO Save Lives: Clean your hands [online] Available from: http://www.who.int/gpsc/5may/ en [Accessed June 2013]

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Infection Control

Eye of the Needle Challenges still to be met in reducing occupational exposures to bloodborne viruses.

There were 541 reports of needle stick injuries that exposed healthcare workers to patients carrying bloodborne viruses in 2011, twice as many as a decade ago (2002) when 271 exposures were reported.

The figures were published in the Health Protection Agency’s (HPA) fourth Eye of the Needle report, which includes occupational exposures to bloodborne viruses in healthcare workers reported by hospitals through the HPA’s enhanced surveillance system.

These reports are only a fraction of needle stick injuries that would have occurred.

Since the previous report, which presented data until the end of 2007, a further 2,039 occupational exposures to known bloodborne virus carriers have been reported in England, Wales and Northern Ireland. Most of these exposures occurred in the ward, theatre, Intensive Care Unit and Accident and Emergency setting, and a major proportion, such as those attributed to non-compliance

with the safe handling of sharps and the disposal of clinical waste, were preventable.

Between 2008 and 2011 there were five patient to healthcare worker transmissions of hepatitis C virus in the UK (three in England and two in Scotland).

The total number of reported hepatitis C cases in healthcare workers now stands at 20 (17 in England and three in Scotland).

Eight of the cases in England occurred after the medical procedure, and most of them could have been prevented with adherence to standard infection control precautions for the safe handling and disposal of clinical waste. The last case of HIV infection in a healthcare worker, following occupational exposure, was in 1999.

Dr Fortune Ncube, an expert in bloodborne viruses at the HPA said “These documented cases of patient to healthcare worker hepatitis C infections are a stark reminder that occupational exposures can result in bloodborne virus infections.

“We are very concerned that healthcare workers are still being put at risk of these serious infections through occupational exposure, many of which are preventable. In line with the EU directive due to come into place in May 2013, the HPA recommends that all relevant healthcare services adopt safety engineered devices in place of conventional devices.

“Our report also re-emphasises

“We are very concerned that healthcare workers are still being put at risk of these serious infections through occupational exposure, many of which are preventable. The HPA recommends that all relevant healthcare services adopt safety engineered devices in place of conventional devices.”

the need for healthcare service providers to ensure that all healthcare professionals are adequately trained on how to prevent injuries, and that appropriate Occupational Health services are in place for the prompt, effective and appropriate management of such incidents.”

Eye of the Needle is available from: www.hpa. org.uk/webc/HPAwebFile/ HPAweb_C/1317137310957

AfPP Theatre Access Course A training session designed to give delegates the competencies required to visit theatres to attend a surgical procedure.

Delegates will develop an understanding of how to comply with infection control guidelines and procedural policies. The course is designed primarily for medical device representatives but would also be relevant to student nurses and work placement students.

AfPP has the infrastructure and credibility to give you the peace of mind that any training your representatives receive will provide them with a thorough understanding of the environment they will be entering.

We can provide training for all your staff regardless of their level/knowledge and ensure that they are all equipped with the same level of understanding

about operating theatre protocol upon completion.

The next available courses are on: 15 August 2013, 17 October 2013 and 19 December 2013.

The course can also be ‘tailor made’ to your specifications. For further information or to book your place, please call Pauline Thompson on 01423 882969, or online at www.afpp.org.uk/events

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Infection Control

Theatre attire The purpose of theatre attire is to provide a barrier that protects the patient from micro-organisms, which are shed into the environment from the skin and hair of theatre personnel, and to protect the outside environment from theatre contaminants.

Theatre attire is designed to minimise the transfer of microorganisms from the mucous membranes, skin and hair of the surgical team to the patient. It also provides the surgical team with some protection from the patient. When selecting theatre clothing (reusable or single-use), it is important to consider the quality of material in relation to the dissemination of airborne bacteria

and bacterial strike-through.

All personnel who enter the restricted area of the theatre suite should don the attire intended for use within the surgical environment.

Sufficient supplies of theatre clothing should be provided daily and clean theatre clothing should be protected from possible contamination during transfer and storage.

Hands should be washed before and after donning theatre attire. Theatre attire should be removed when it becomes wet or soiled, and placed into containers specially

designed for contaminated laundry, to reduce the potential for cross-contamination.

Theatre attire should be changed following environmental cleaning of the operating theatre and before the commencement of a new operating list.

Theatre attire should be removed before leaving the theatre environment and placed into an appropriate container.

When leaving the clinical area, personnel should change into their outdoor clothes. • •

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Fresh, clean attire should be donned on return to theatre.

Used theatre attire should not be stored in lockers for further use.

Theatre attire should not be worn outside the clinical area or in public places.

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Infection Control

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Best Pratcice

Guide to best practice for safe handling of surgical sharps With over 400,000 occupational injuries reported each year, aspects of the EU Sharps Directive 2010/32/EU are to be implemented from the 11th May 2013 under the Health and Safety (Sharps Instruments in Healthcare) Regulations 2013 which aim to achieve the safest possible environment for healthcare workers through the prevention of sharps related injuries.

The objectives of the EU legislation can be summarised as: 1. To achieve the safest possible working environment.

2. To prevent workers injuries caused by medical sharps.

3. To protect workers at risk.

4. To set up an integrated approach establishing policies in risk assessment, risk prevention, training, information awareness raising and monitoring.

5. To put in place response and follow up procedures.

The prevention of injuries caused by all medical sharps is the

overriding objective of the new directive and this is hoped to be achieved by applying a number of control measures within the working environment

of medical devices incorporating safety mechanisms and protection.

4. PPE - the use of personal protective equipment such as gloves, gowns and masks.

These would be: 1. Elimination of unnecessary use of sharps through changes in working practice identified during risk assessment.

2. Safe procedures to be clearly specified and implemented for the use and disposal of sharp medical instruments and contaminated waste.

3. Engineering controls enabling the provision

Have you any ‘New Products’ to launch or ‘Established Products’ you wish to push to the forefront of the ‘NHS Supply Chain & Private Sector’?

Reference This is an extract from AfPP’s latest poster, sponsored by Swann Morton: Association of Perioperative Practice 2013 Guide to best practice for safe handling of surgical sharps (poster) Harrogate, AfPP Available from: www.afpp.org.uk/careers/ Standards-Guidance

Call our sales contact, Frances, to discuss including them in our upcoming editions

Frances Murphy +

44 (0)121 200 7820

The Association for Perioperative Practice is a registered charity (number 1118444) and a company limited by guarantee, registered in England (number 6035633). AfPP Ltd is its wholly owned subsidiary company, registered in England (number 3102102).

The registered office for both companies is Daisy Ayris House, 42 Freemans Way, Harrogate, HG3 1DH.

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