ESSENTIALS: SAFETY
Infection control
eBook
Contents
2 Understanding infection
4 Roles, responsibilities and the law
5 The chain of infection
7 Workplace examples
8 Risk assessment
12 Hand and workplace hygeine
14 Personal protective equipment
15 Safe working guidelines
17 APPENDIX: Estimating the level of risk
ESSENTIALS: SAFETY
Infection control
Understanding infection...
What is an infection?
An infection happens when your body is invaded by organisms or microorganisms that then
multiply, use the body’s resources for food and cause illness. It is an infection only
if the invading micro-organisms harm your body and affect your health.
Colonisation
Humans live with colonies of bacteria, for example, in the intestine, that
help rather than harm us and their normal growth is not an infection.
Who is at risk?
We are all at risk of picking up infections at work, but some of us can be more at risk or more
affected than others. People whose immune systems are weak because they are:
Young, elderly or ill
are more likely to pick up infections and then likely to suffer more
Risk is the likelihood that a hazard (the infectious agents or bugs) will cause harm.
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What causes infection?
Bacteria
Bacteria are simple, single-celled micro-organisms. Once they have
invaded a body, they begin to multiply using the body's resources.
They release toxins into the body that cause illness. Bacterial
infections can be successfully treated with antibiotics.
Common bacterial infections
• food poisoning • cholera
• typhoids • whooping cough
Viruses
Salmonella bacteria
Viruses are very small micro-organisms which can only survive and
reproduce inside a living cell. They attack the body by invading a cell,
using it to make copies of themselves and then destroying the cell
when they exit. Viral infections do not respond to antibiotics.
Common viral infections
• cold • flu
• chicken pox • shingles
• warts • mononucleosis
F ungi Hepatitis C virus
A fungus is a simple, plant-like organism that lives on a host. For
example the athlete’s foot fungus feeds on dead skin cells in damp
conditions.
Common fungal infections
• athlete’s foot
• ringworm
• yeast infections such as thrush
Parasites Athlete's foot
Parasites can be complex organisms like worms
that live in a host body and use their host’s
resources for nutrition, survival and reproduction.
Common parasitic infections
• malaria
• intestinal worms
• fleas
• lice
• scabies A flea
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Roles, responisibilities and the law...
Employer responsibilities...
A number of laws, Acts and regulations govern infection control. To comply with
the law, we as employers must:
• Assess the risk of exposure to infections
• Decide what controls and measures are needed to eliminate or reduce the risks
• Put infection control procedures and processes in place to carry them out
• Make the controls work and are used
• Provide suitable personal protective equipment
• Provide regular training and information
• Ensure a clean working environment
Acts and Regulations
Employer responsibilities...
KEY ACTS...
As an employee you must:
• Health and Safety at Work Act 1974
• Take care of your own health and safety,
and that of others • Control of Substances Hazardous to Health
Regulations (COSHH) 2002
• cooperate with employer on safety matters.
• Reporting of injuries, diseases & dangerous
This means you need to: occurrences regulations (RIDDOR) 1995
• Know and use of any control measures
including personal protective equipment, ADDITIONAL ACTS...
• Follow safe systems of work • The Public Health (Infectious Diseases)
• Cooperate with policies and procedures Regulations 1988
• Abide by local rules • The Food Safety and Hygiene (England)
• Report hazards and potential risks. Regulations 2013
• The Food Hygiene (Wales) Regulations 2013
• Health Protection Agency Act 2004
• Hazardous Waste Regulations 2005
• The Health and Social Care Act 2008
• Management of Health and Safety at Work
Regulations 1999
• Environmental Protection Act 1990
Employers
• Personal protective equipment work
must ensure, as regulations (PPE) 1992
far as reasonably
• Safe disposal of clinical waste 1992
practicable, the
• Hazardous Waste Regulations (2005)
health, safety and
• Safe Management of Healthcare Waste (2006)
welfare at work of all
employees. • Health Act (2006)
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Use the next page to help you!
The chain of infection...
The Chain of Infection describes how infection spreads from one person to another. Describe
typical chains of infection in your workplace. Then consider how you might break the chain.
Chain of infection Breaking the chain
Infectious agents
Enough
micro-organisms
to cause infection
Reservoir
A place where the
micro-organisms
can grow
Portal of exit
A route out of
the reservoir
Mode of
transmission
A way to travel
from host to host
Portal of entry
A route into
the new host
Susceptible host
The host has to
be vulnerable
to infection
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Possible modes of transmission...
Workplace
Surfaces Food People Technology Toilets
specifics
Keyboard,
Handles, Out of date or Sneezing and Like the floor Taps,
mouse, tablet
stair rails, undercooked coughing in gyms and dispensers and
and phone
escalators. food droplets pools towels
screens
Breaking the chain...
Infectious agents
• Immunise.
Enough micro-
• Isolate the infectious person.
organisms to cause • Get an early diagnosis.
infection.
Reservoir
• Remove infected food, waste, water. A place where the
• Isolate the infectious person. micro-organisms can
grow
Portal of exit • Cover nose or mouth when sneezing or coughing.
A route out of the • Use disposable tissues.
reservoir • Dispose of (potentially) infected materials immediately.
• Use correct handwashing technique. Mode of transmission
• Clean thoroughly to remove infectious agents. A way to travel from
• Use single use tissues and paper towels. host to host
Portal of entry • Wash your hands regularly and before eating.
A route into the new • Use gloves to prevent skin contact/transfer to mouth.
host • Use clean/sterile utensils/equipment.
• Immunise. Susceptible host
• Lead a healthy lifestyle. The host has to be
• Maintain a high standard of personal hygiene. vulnerable to infection
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Workplace examples...
These examples aren’t exhaustive but you can use them to think about your own workplace
to think how you can practically break the chain of infection.
Cleaning...
People who clean toilets or other potentially hazardous areas should
wear gloves (personal protective equipment) while working and
when finished, wash their hands correctly. This breaks the chain
by stopping micro-organisms transferring from the surfaces to the
person’s hands and then their mouth.
Looking after old and young...
People working with young children should wear gloves and bag soiled
clothing, without rinsing, so it can be taken home. This breaks the chain
by reducing chance of infectious micro-organisms transferring to other
people including colleagues. Potentially contaminated towels, sheets
or spare clothing that are the organisation’s responsibility is washed in
as hot a wash as the fabric can bear. This breaks the chain by getting
rid of infectious agents. If dealing with diarrhoea & vomiting, workers
wear PPE likes gloves and aprons to prevent clothing & skin picking up
infectious micro organisms breaking the chance of transmission.
Ear piercing and acupuncture...
The chain of infection can be broken by...
...sterilising needles to remove blood and infectious agents such
as HIV and Hepatitis
...using once-only pre-sterilised needles to avoid infectious agents
...using gloves + correct handwashing technique; mode of transmission
...disinfecting the recipient’s skin – portal of entry
Health centres and public buildings...
In health centres, water systems are treated to kill infectious agents
such as Legionella bacteria so that showers, pool and spas are free of
infection. In hotels, businesses, schools, and other public buildings,
water systems and air conditioning units are also closely managed
and monitored to ensure that they are free of infectious agents.
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Risk assessment...
Employers have to conduct infection control risk assessments in the same way as they do
any other health and safety issue. A risk assessment needs to be done if the risk of infection
at work is greater than normal for staff, customers, visitors or contractors. Risk assessments
also need to be living documents – reviewed and updated on a regular basis and when things
change. Even if you don’t have to do risk assessments, it may help you to understand how the
process works so you can judge risks of infection yourself.
Review the
results Identify the
hazards
Implement
the plan
Decide who
could be at risk
Create an
action plan
Estimate the
level of risk
Record the
findings
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Identify the hazards
Sources of infection
Look for four broad sources of infection:
• Coughs and sneezes that release micro-organisms from someone’s respiratory tract
• Direct contact via skin or infected surfaces
• Blood and other body fluids (e.g.: saliva), human and animal (e.g.: raw meat)
• Human or animal waste: faeces, urine, vomit
How infection might enter the body
• Touching the mouth, nose or eyes with an infected hand or object or food
• Breathing in contaminated particles, e.g.: other people’s coughs/sneezes, water spray
• Splashes of blood or body fluid entering the nose, eyes or mouth
• Open wounds/broken skin that come into contact with infectious agents
• Skin pierced with contaminated sharp objects such as needles, glass or by an insect
Level of risk
Please see appendix.
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Sample risk assessment...
Name of organisation ABC Care Housing
Name of assessor John Smith Assessment date 01/03/2017
Business description Residential warden controlled community housing for elderly people
• Infection control in residents shared areas including a self
What are you assessing?
help kitchen. Events are organised by the management.
• Residents can catch infections from other residents when
What are the possible communal kitchen and shared equipment is not hygienic.
source(s) of infection? • Shared fridge presents risk of food infection.
• Shared waste bin presents risk of attracting pests.
• Bi weekly ‘share a cuppa’ events
What are the quantities
• Saturday evening film night with refreshments
handled? What is the
• Ad hoc use for residents during the day
frequency of contact?
• Events organised by visitors such as parties
Those at risk from • Staff, contractors and visitors
sources of infection... • All residents who are a vulnerable population
Given frequency of use, capability of residents and their vulnerability
What is the level of risk?
to infection, level and likelihood of harm are high
• Can't eliminate risk, can control with robust cleaning scheme.
Can the hazard be
• Installation of dish washer with instructions to use it
eliminated? If not, what
• Weekly fridge clean. Daily checks remove out of date items
can be done to minimise
• Bi weekly cleaning of bin.
and control the risks?
• Hand sanitizer dispenser installed
• Cleaning staff trained in infection control standard procedures.
What measures can be E.g.: including effective hand washing technique
put in place to ensure • Cleaning schedule on the wall and completed tasks logged.
success? • Cleaning staff wear appropriate PPE
• Supervisory checks done regularly and results monitored
When will you action
• See attached schedule
these?
When will you review
• Statistical reviews will be done monthly.
effectiveness of the
• If an infection spreads
actions?
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Your own risk assessment...
Use this form to practise assessing infection control risks in your workplace.
Name of organisation
Name of assessor Assessment date
General business description
What activity are you
assessing?
What are the possible
source(s) of infection?
What are the quantities
handled? What is the
frequency of contact?
List those who're at risk from
sources of infection here...
What is the level of risk?
Can the hazard be
eliminated? If not, what can
be done to minimise and
control the risks?
What measures can be put in
place to ensure success?
When will you action these?
When will you review
effectiveness of the actions?
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Hand and workplace hygiene...
Washing your hands...
You may have to show that you know how to wash your hands correctly. Here’s a guide to
help you.
Step 1: Prepare
Washing with
Soap
Wet hands with Apply enough soap to
warm water cover hands completely
Step 2: Wash
Rub back of each Rub your palms Rub back of fingers
hand with palm together with on other palm,
of the other with fingers interlaced fingers interlocked
fingers interlaced & visa versa.
Clasp left thumb Rub left palm with Rub left wrist with
with right hand, clasped fingers of right right hand & visa
rub & visa versa hand & visa versa versa
Step 3: Rinse & dry
Rinse your hands Dry your hands
thoroughly thoroughly
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Washing with
Alcohol gel
Apply enough Put palms Rub back of each
gel or foam to together and rub hand with palm
cover your hands of the other with
thoroughly fingers interlaced.
Rub your palms Rub back of fingers Clasp left thumb
together with on other palm, with right hand,
fingers interlaced fingers interlocked & rub & visa versa
visa versa.
Rub left palm with Rub left wrist with
clasped fingers of right right hand & visa
hand & visa versa versa
Once dry, your hands are safe.
BE AWARE More frequently
missed
Some areas of the hands
often miss out on thorough
cleaning. Once you know
where they are, you can pay
more attention to them. Less frequently
missed
Rarely missed
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Personal protective equipment...
Complete this table with your supervisor if possible.
How is it
Type of PPE What will you use? When will you use it?
maintained?
Body
Protective clothing
E.g. Aprons
Eyes and face
Goggles and visors
Nose & Mouth
Mask
Hands & Arms
Gloves
Legs & Feet
Boots and shoes
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Safe working guidelines...
Here's some standard guidelines with space for you to add any specific to your workplace.
Wash hands (and arms if necessary) before touching eyes, nose or mouth. E.g.: eating,
drinking, smoking, taking medicine, applying make-up, inserting contact lenses.
Cover wounds, cuts and grazes with waterproof dressings and/or gloves.
If you cut or graze yourself, wash, disinfect and cover it with a waterproof dressing
Take your breaks away from the main work area.
Use, store, clean and dispose of PPE as instructed
Avoid hand-mouth or hand-eye contact – don’t put pens/pencils in mouths.
Don’t’ let waste pile up and dispose of contaminated waste, such as tissues, safely.
Clean all work surfaces/work areas/touch screens, keyboards and mice regularly.
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Our obligations...
These are our obligations under the various pieces of law relating to infection control.
Have we assessed the risks and implemented appropriate control measures?
Have we given clear information about risks and controls?
Have we provided adequate Personal Protective Equipment and instructions on
how to use it?
Have we instructed you on specific safe ways of working?
Have we given you clear instructions on what to do if you have an infectious illness?
Your outcomes...
Do you know what causes infection?
Can you name the four broad sources of infection?
Can you describe the six steps in the chain of infection?
Can you describe a typical chain of infection in your workplace and how you can
break it?
Can you describe how to break the chain of infection?
Have you familiarised yourself with safe ways of working and our standard
infection control procedures?
Do you know what PPE you should use and when? Does your PPE fit correctly?
Can you wash your hands effectively?
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APPENDIX: Estimating the level of risk...
Severity...
Estimate the severity of the harm the hazard could cause and assign a numerical value:
Minor harm 1 Less than 3 days off work
Moderate harm 2 More than 3 days off work
Serious harm 3 Death or major injury
Likelihood...
Step two is to estimate how likely the harmful event is to actually occur:
Unlikely 1
Reasonable chance 2
Likely 3
Multiply severity and likelihood together...
For example: a hazard is assessed as being able to cause serious harm and it is estimated
that it has a reasonable chance of occurring.
Severity x Likelihood = Level of risk
Serious harm x Reasonable chance = High risk
3 x 2 = 6
Interpret the results...
This table shows all the Severity
possible results. Minor harm Moderate harm Serious harm
Unlikely 1 2 3
Likelihood
Reasonable chance 2 4 6
Likely 3 6 9
Interpret the results...
Category of risk Action
High risk Reduce risk immediately: eliminate the hazard or apply more controls.
Medium risk Reduce risk in a few days: eliminate the hazard or apply more controls.
Low risk Accept unless the likelihood is 2 or 3. If so, reduce risk in a few days:
Very low risk Accept risk or take action to eliminate risk when resources allow.
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NOTES
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NOTES
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Look out for other titles in the series
Asbestos Awareness Legionella Awareness
COSHH Managing Risk
Display Screen Equipment Manual Handling
Driving at Work - Economical Driving New and Expectant Mothers
Driving at Work - Your Safety Noise Awareness
Electrical Safety Personal Protective Equipment
Environmental Awareness Positive Mental Health Awareness
Fire Safety Risks and Responsibilities
First Aid Slips and Trips
Food Safety - Catering Stress in the Workplace
Health & Safety in the Office Suspicious Packages
Infection Control Working at Height
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