NATIONAL INFECTION PREVENTION AND CONTROL

Patient Safety
Key facts:
 Around 1 in every 10 patients is harmed in health care and more than 3 million deaths occur annually
due to unsafe care. In low-to-middle income countries, as many as 4 in 100 people die from unsafe
care (1).
 Above 50% of harm (1 in every 20 patients) is preventable; half of this harm is attributed to
medications (2,3).
 Some estimates suggest that as many as 4 in 10 patients are harmed in primary and ambulatory
settings, while up to 80% (23.6–85%) of this harm can be avoided (4).
 Common adverse events that may result in avoidable patient harm are medication errors, unsafe
surgical procedures, health care-associated infections, diagnostic errors, patient falls, pressure ulcers,
patient misidentification, unsafe blood transfusion and venous thromboembolism.
 Patient harm potentially reduces global economic growth by 0.7% a year. On a global scale, the
indirect cost of harm amounts to trillions of US dollars each year (1).
 Investment in reducing patient harm can lead to significant financial savings, and more importantly
better patient outcomes (5). An example of a good return on investment is patient engagement, which,
if done well, can reduce the burden of harm by up to 15% (4).
Nonmaleficence “First, do no harm” is the most fundamental principle of any health care service. No one should be
harmed in health care; however, there is compelling evidence of a huge burden of avoidable patient harm globally
across the developed and developing health care systems. This has major human, moral, ethical and financial
implications.
Patient safety is defined as “the absence of preventable harm to a patient and reduction of risk of unnecessary harm
associated with health care to an acceptable minimum." Within the broader health system context, it is “a
framework of organized activities that creates cultures, processes, procedures, behaviours, technologies and
environments in health care that consistently and sustainably lower risks, reduce the occurrence of avoidable harm,
make error less likely and reduce impact of harm when it does occur."
Common sources of patient harm
Medication errors. Medication-related harm affects 1 out of every 30 patients in health care, with more than a
quarter of this harm regarded as severe or life threatening. Half of the avoidable harm in health care is related to
medications (3).
Surgical errors. Over 300 million surgical procedures are performed each year worldwide (6). Despite awareness
of adverse effects, surgical errors continue to occur at a high rate; 10% of preventable patient harm in health care
was reported in surgical settings (2), with most of the resultant adverse events occurring pre- and post-surgery (7).
Health care-associated infections. With a global rate of 0.14% (increasing by 0.06% each year), health care-
associated infections result in extended duration of hospital stays, long-standing disability, increased antimicrobial
resistance, additional financial burden on patients, families and health systems, and avoidable deaths (8).
Sepsis. Sepsis is a serious condition that happens when the body’s immune system has an extreme response to an
infection. The body’s reaction causes damage to its own tissues and organs. Of all sepsis cases managed in
hospitals, 23.6% were found to be health care associated, and approximately 24.4% of affected patients lost their
lives as a result (9).
Diagnostic errors. These occur in 5–20% of physician–patient encounters (10,11). According to doctor reviews,
harmful diagnostic errors were found in a minimum of 0.7% of adult admissions (12). Most people will suffer a
diagnostic error in their lifetime (13).
Patient falls. Patient falls are the most frequent adverse events in hospitals (14). Their rate of occurrence ranges
from 3 to 5 per 1000 bed-days, and more than one third of these incidents result in injury (15), thereby reducing
clinical outcomes and increasing the financial burden on systems (16).
Venous thromboembolism. More simply known as blood clots, venous thromboembolism is a highly burdensome
and preventable cause of patient harm, which contributes to one third of the complications attributed to
hospitalization (17).
Pressure ulcers. Pressure ulcers are injuries to the skin or soft tissue. They develop from pressure to particular
parts of the body over an extended period. If not promptly managed, they can have fatal complications. Pressure
ulcers affect more than 1 in 10 adult patients admitted to hospitals (18) and, despite being highly preventable, they
have a significant impact on the mental and physical health of individuals, and their quality of life.
Unsafe transfusion practices. Unnecessary transfusions and unsafe transfusion practices expose patients to the risk
of serious adverse transfusion reactions and transfusion-transmissible infections. Data on adverse transfusion
reactions from a group of 62 countries show an average incidence of 12.2 serious reactions per 100 000 distributed
blood components.
Patient misidentification. Failure to correctly identify patients can be a root cause of many problems and has
serious effects on health care provision. It can lead to catastrophic adverse effects, such as wrong-site surgery. A
report of the Joint Commission published in 2018 identified 409 sentinel events of patient identification out of 3326
incidents (12.3%) between 2014 and 2017 (19).
Unsafe injection practices. Each year, 16 billion injections are administered worldwide, and unsafe injection
practices place patients and health and care workers at risk of infectious and non-infectious adverse events. Using
mathematical modelling, a study estimated that, in a period of 10 years (2000–2010), 1.67 million hepatitis B virus
infections, between 157 592 and 315 120 hepatitis C virus infections, and between 16 939 and 33 877 HIV
infections were associated with unsafe injections (20).
Factors leading to patient harm
Patient harm in health care due to safety breaks is pervasive, problematic and can occur in all settings and at all
levels of health care provision. There are multiple and interrelated factors that can lead to patient harm, and more
than one factor is usually involved in any single patient safety incident:
  system and organizational factors: the complexity of medical interventions, inadequate processes and
procedures, disruptions in workflow and care coordination, resource constraints, inadequate staffing and
competency development;
 technological factors: issues related to health information systems, such as problems with electronic health
records or medication administration systems, and misuse of technology;
 human factors and behaviour: communication breakdown among health care workers, within health care
teams, and with patients and their families, ineffective teamwork, fatigue, burnout, and cognitive bias;
 patient-related factors: limited health literacy, lack of engagement and non-adherence to treatment; and
 external factors: absence of policies, inconsistent regulations, economic and financial pressures, and
challenges related to natural environment.
System approach to patient safety
Most of the mistakes that lead to harm do not occur as a result of the practices of one or a group of health and care
workers but are rather due to system or process failures that lead these health and care workers to make mistakes.
Understanding the underlying causes of errors in medical care thus requires shifting from the traditional blaming
approach to a more system-based thinking. In this, errors are attributed to poorly designed system structures and
processes, and the human nature of all those working in health care facilities under a considerable amount of stress
in complex and quickly changing environments is recognized. This is done without overlooking negligence or
misbehaviour from those providing care that leads to substandard medical management.
A safe health system is one that adopts all necessary measures to avoid and reduce harm through organized
activities, including:
 ensuring leadership commitment to safety and creation of a culture whereby safety is prioritized;
 ensuring a safe working environment and the safety of procedures and clinical processes;
 building competencies of health and care workers and improving teamwork and communication;
 engaging patients and families in policy development, research and shared decision-making; and
 establishing systems for patient safety incident reporting for learning and continuous improvement.
Investing in patient safety positively impacts health outcomes, reduces costs related to patient harm, improves
system efficiency, and helps in reassuring communities and restoring their trust in health care systems (4,5).
WHO response
Global action on patient safety
Recognizing patient safety as a global health priority, and as an essential component of strengthening health
systems for moving towards universal health coverage, the Seventy-second World Health Assembly adopted
resolution WHA72.6 on “Global action on patient safety” in May 2019.
The resolution requested the Director-General to emphasize patient safety as a key strategic priority in WHO’s work
across the universal health coverage agenda, endorsed the establishment of World Patient Safety Day to be observed
annually on 17 September, and requested WHO’s Director-General to develop a global patient safety action plan
with the involvement of WHO Member States, partners and other relevant stakeholders.
Global Patient Safety Action Plan 2021–2030
The Global Patient Safety Action Plan 2021–2030 provides a framework for action for key stakeholders to join
efforts and implement patient safety initiatives in a comprehensive manner. The goal is “to achieve the maximum
possible reduction in avoidable harm due to unsafe health care globally”, envisioning “a world in which no one is
harmed in health care, and every patient receives safe and respectful care, every time, everywhere”.
World Patient Safety Day
Since 2019, World Patient Safety Day has been celebrated across the world annually on 17 September, calling for
global solidarity and concerted action by all countries and international partners to improve patient safety. The
global campaign, with its dedicated annual theme, is aimed at enhancing public awareness and global understanding
of patient safety and mobilizing action by stakeholders to eliminate avoidable harm in health care and thereby
improve patient safety.
WHO Flagship initiative “A Decade of Patient Safety 2021–2030”
WHO has launched the Patient Safety Flagship as a transformative initiative to guide and support strategic action
on patient safety at the global, regional and national levels. Its core work involves supporting the implementation of
the Global Patient Safety Action Plan 2021–2030.
The Chain of Infection
By understanding this chain, healthcare providers can implement strategies to break it at various points, thereby
preventing infection
To understand infection control, it's helpful to understand the chain of infection, which includes six links:
1. Infectious Agent: The pathogen causing the infection.
2. Reservoir: Where the pathogen lives and multiplies (e.g., a human, animal, or the environment).
3. Portal of Exit: The way the pathogen leaves the reservoir (e.g., through the mouth or a wound).
4. Mode of Transmission: How the pathogen travels from one host to another.
5. Portal of Entry: The way the pathogen enters a new host.
6. Susceptible Host: An individual who is vulnerable to the pathogen.

Standard infection control precautions (SICPs)

Standard infection control precautions (SICPs) are to be used by all staff, in all care settings, at all times, for
all patients whether infection is known to be present or not, to ensure the safety of those being cared for, staff and
visitors in the care environment.
SICPs are the basic infection prevention and control measures necessary to reduce the risk of transmitting infectious
agents from both recognised and unrecognised sources of infection.
Sources of (potential) infection include blood and other body fluids, secretions or excretions (excluding sweat),
non-intact skin or mucous membranes and any equipment or items in the care environment that could have become
contaminated.
The application of SICPs during care delivery is determined by assessing risk to and from individuals. This includes
the task, level of interaction and/or the anticipated level of exposure to blood and/or other body fluids.
To protect effectively against infection risks, SICPs must be used consistently by all staff. SICPs implementation
monitoring must also be ongoing to ensure compliance with safe practices and to demonstrate ongoing commitment
to patient, staff and visitor safety as required by the Health and Safety Executive and the care regulators, the Care
Quality Commission.
There are 10 elements of SICPs:
1. patient placement/assessment of infection risk
2. hand hygiene
3. respiratory and cough hygiene
4. personal protective equipment
5. safe management of the care environment
6. safe management of care equipment
7. safe management of healthcare linen
8. safe management of blood and body fluids
9. safe disposal of waste (including sharps)
10. occupational safety/managing prevention of exposure (including sharps)
1. Patient placement/assessment for infection risk
Patients must be promptly assessed for infection risk on arrival at the care area, eg inpatient/outpatient/care home,
(if possible, prior to accepting a patient from another care area) and should be continuously reviewed throughout
their stay.
This assessment should influence placement decisions in accordance with clinical/care need(s).
Patients who may present a cross-infection risk include those:
 with diarrhoea, vomiting, an unexplained rash, fever or respiratory symptoms
 known to have been previously positive with a multi-drug resistant organism (MDRO), eg MRSA, CPE
 who have been an inpatient in any hospital in the UK or abroad or are a known epidemiological link to a
carrier of CPE.
2. Hand hygiene
Hand hygiene is considered one of the most important ways to reduce the transmission of infectious agents
that cause healthcare associated infections (HCAIs).
Clinical hand-wash basins must:
be used for that purpose only and not used for the disposal of other liquids
have mixer taps, no overflow or plug and be in a good state of repair
have wall mounted liquid soap and paper towel dispensers.
Hand hygiene facilities should include instructional posters.

Before performing hand hygiene:

 expose forearms (bare below the elbow). If disposable over-sleeves are worn for religious reasons,
these must be removed and disposed of before performing hand hygiene, then replaced with a new
pair*
 remove all hand and wrist jewelry. The wearing of a single, plain metal finger ring, eg a wedding
band, is permitted but should be removed (or moved up) during hand hygiene. A religious bangle
can be worn but should be moved up the forearm during hand hygiene and secured during patient
care activities
 ensure fingernails are clean and short, and do not wear artificial nails or nail products
 cover all cuts or abrasions with a waterproof dressing.

To perform hand hygiene:

Wash hands with non-antimicrobial liquid soap and water if:

 hands are visibly soiled or dirty
 caring for patients with vomiting or diarrhoeal illnesses
 caring for a patient with a suspected or known gastrointestinal infection, eg norovirus or a spore-forming
organism such as clostridioides difficile.

In all other circumstances, use alcohol-based handrubs (ABHRs) for routine hand hygiene during care.
ABHRs must be available for staff as near to the point of care as possible. Where this is not practical,
personal ABHR dispensers should be used, eg within the community, domiciliary care, mental health units
etc.
Where running water is unavailable, or hand hygiene facilities are lacking, staff may use hand wipes
followed by ABHR and should wash their hands at the first opportunity.

Perform hand hygiene:

 before touching a patient.
 before clean or aseptic procedures.
 after body fluid exposure risk
 after touching a patient; and
 after touching a patient’s immediate surroundings.
Always perform hand hygiene before putting on and after removing gloves.

Skin care
 dry hands thoroughly after hand washing, using disposable paper towels
 use an emollient hand cream regularly eg during breaks and when off duty
 do not use or provide communal tubs of hand cream in the care setting
 staff with skin problems should seek advice from occupational health or their GP and depending on their
skin condition and the severity may require additional interventions or reporting.
Surgical hand antisepsis
Surgical scrubbing/rubbing (this applies to those undertaking surgical and some invasive procedures):
 perform surgical scrubbing/rubbing before donning sterile theatre garments or at other times, eg before
inserting central vascular access devices
 remove all hand and wrist jewellery (including wedding band)
 nail brushes should not be used for surgical hand antisepsis
 nail picks (single-use) can be used if nails are visibly dirty
 soft, non-abrasive, sterile (single-use) sponges may be used to apply antimicrobial liquid soap to the skin if
licensed for this purpose
 use an antimicrobial liquid soap licensed for surgical scrubbing or an ABHR licensed for surgical rubbing
(as specified on the product label)
 ABHR can be used between surgical procedures if licensed for this use or between glove changes if hands
are not visibly soiled.
3. Respiratory and cough hygiene
Respiratory and cough hygiene is designed to minimise the risk of cross transmission of known or suspected
respiratory illness (pathogens)-containing respiratory secretions:
 cover the nose and mouth with a disposable tissue when sneezing, coughing, wiping and blowing the nose;
if unavailable use the crook of the arm
 dispose of all used tissues promptly into a waste bin
 wash hands with non-antimicrobial liquid soap and warm water after coughing, sneezing, using tissues, or
after contact with respiratory secretions or objects contaminated by these secretions
 where there is no running water available or hand hygiene facilities are lacking, staff may use hand wipes
followed by ABHR and should wash their hands at the first available opportunity
 keep contaminated hands away from the eyes nose and mouth.
Staff should promote respiratory and cough hygiene helping those (eg, elderly, children) who need
assistance with this, eg providing patients with tissues, a dedicated receptacle i.e. waste bag for used tissues
and hand hygiene facilities as necessary.

4. Personal protective equipment (PPE)

 Before undertaking any procedure, staff should assess any likely exposure to blood and/or other body fluids,
non-intact skin or mucous membranes and wear personal protective equipment (PPE) that protects
adequately against the risks associated with the procedure. The principles of PPE use set out below are
important to ensure that PPE is used correctly to ensure patient and staff safety. Avoiding overuse or
inappropriate use of PPE is a key principle that ensures this is risk-based and minimizes its environmental
impact. Where appropriate, consideration should be given to the environmental impact of sustainable or
reusable PPE options versus single-use PPE while adhering to the principles below.

All PPE must be:

 located close to the point of use. PPE for healthcare professionals providing care in the community and
domiciliary care providers must be transported in a clean receptacle
 stored to prevent contamination in a clean, dry area until required (expiry dates must be adhered to)
 single-use only unless specified by the manufacturer
 changed immediately after each patient and/or after completing a procedure or task
 disposed of after use into the correct waste stream, eg domestic waste, offensive (non-infectious) or clinical
waste
 discarded if damaged or contaminated.

NB Reusable PPE such as goggles/face shields/visors, must be decontaminated after each use according to
manufacturer’s instruction.

Gloves must be:

 worn when exposure to blood and/or other body fluids, non-intact skin or mucous membranes is anticipated
or likely
 changed immediately after each patient and/or after completing a procedure/task even on the same patient,
and hand hygiene performed
 changed if a perforation or puncture is suspected
 appropriate for use, fit for purpose and well-fitting
 never decontaminated with ABHR or soap between use
 low risk of causing sensitisation to the wearer
 appropriate for the tasks being undertaken, taking into account the substances being handled, type and
duration of contact, size and comfort of the gloves, and the task and requirement for glove robustness and
sensitivity.

Sterile gloves must be worn:

 when sterility is required in an operating theatre, and

 for some aseptic techniques eg insertion of central venous catheters, insertion of peripherally inserted
central catheters, insertion of pulmonary artery catheters and spinal, epidural and caudal procedures

NB Double gloving is NOT recommended for routine clinical care. However, it may be required for some
exposure prone procedures, eg orthopaedic and gynaecological operations, when attending major trauma
incidents or as part of additional precautions for high consequence infectious disease management.
 Gloves are NOT required to carry out near patient administrative tasks, eg, when using the telephone, using
a computer or tablet, writing in the patient chart; giving oral medications; distributing or collecting patient
dietary trays.

If worn, oversleeves must be:

 changed immediately after each patient and/or after completing a procedure/task even on the same patient,
and hand hygiene performed
 removed and disposed of if visibly contaminated or soiled.

Aprons must be:

 worn to protect uniform or clothes when contamination is anticipated or likely

 changed between patients and/or after completing a procedure or task.

Full body gowns or fluid-resistant coveralls must be:

 worn when there is a risk of extensive splashing of blood and/or body fluids, eg operating theatre, ITU
 worn when a disposable apron provides inadequate cover for the procedure or task being performed
 changed between patients and removed immediately after completing a procedure or task
 sterile when sterility is required in an operating theatre and for some aseptic techniques eg for insertion of
central venous catheters, insertion of peripherally inserted central catheters, insertion of pulmonary artery
catheters and spinal, epidural and caudal procedures.

Eye or face protection (including full-face visors) must:

 be worn if blood and/or body fluid contamination to the eyes or face is anticipated or likely, eg by members
of the surgical theatre team and always during aerosol generating procedures; regular corrective spectacles
are not considered eye protection
 not be impeded by accessories such as piercings or false eyelashes
 not be touched when being worn.

Fluid resistant surgical face masks (FRSM):

Surgical face masks are required:

 as a means of source control, eg to protect the patient from the wearer during sterile procedures such as
surgery, and
 to protect the wearer when there is a risk splashing or spraying of blood, body fluids, secretions or
excretions onto the respiratory mucosa.
 as an element of PPE for droplet precautions (see section 2.4 and appendices 5b and 6).

FRSM must be:

 worn (with eye protection) if a full-face visor is not available and spraying or splashing of blood, body
fluids, secretions or excretions onto the respiratory mucosa (nose and mouth) is anticipated or likely (Type
IIR)
 worn to protect patients from the operator as a source of infection, eg when performing surgical procedures
or epidurals or inserting a central vascular catheter (CVC) (Type II (not classed as an FRSM) or Type IIR)
 well-fitting and fit for purpose, fully covering the mouth and nose (manufacturers’ instructions must be
followed to ensure effective fit and protection)
 removed or changed:
‒ at the end of a procedure/task
‒ if the mask’s integrity is breached, eg from moisture build-up after extended use or from gross
contamination with blood or body fluids
‒ in accordance with manufacturers’ specific instructions.

Footwear must be:

 visibly clean, non-slip and well-maintained, and support and cover the entire foot to avoid contamination
with blood or other body fluids or potential injury from sharps
 removed before leaving a care area where dedicated footwear is used, eg theatre; these areas must have a
decontamination schedule with responsibility assigned.

Headwear

Headwear is not routinely required in clinical areas unless part of theatre attire or to prevent contamination
of the environment such as in clean rooms.

Headwear must be:

 worn in theatre settings and clean rooms, eg central decontamination unit

 well-fitting and completely cover the hair
 changed or disposed of between clinical procedures/lists or tasks and if contaminated with blood and/or
body fluids
 removed before leaving the theatre or clean room
 individuals with facial hair must also cover this in areas where headwear is required, eg wear a snood.

NB Headwear worn for religious reasons such as turbans, kippot veils, headscarves must not compromise
patient care and safety. These must be washed and/or changed daily or immediately if contaminated and
comply with additional attire requirements, for example, in theatres.

5. Safe management of care equipment

Care equipment is easily contaminated with blood, other body fluids, secretions, excretions and infectious
agents. Consequently, it is easy to transfer infectious agents from communal care equipment during care
delivery.

Care equipment is classified as either:

 single use: equipment which is used once on a single patient then discarded. This
equipment must never be re-used. The packaging will carry the symbol of the number two in a circle with a
diagonal cross
 single patient use: equipment which can be reused on the same patient and may require decontamination in-
between use such as nebuliser masks
 reusable invasive equipment: used once then decontaminated, eg surgical instruments and solid state
reusable equipment, such as, flexible endoscopes and transducers
 reusable non-invasive equipment: (often referred to as communal equipment) – reused on more than one
patient following decontamination between each use, eg commode, patient transfer trolley.

NB Needles and syringes are single use devices, they should never be used more than once or reused to
draw up additional medication. Never administer medications from a single-dose vial or intravenous (IV)
bag to multiple patients.

Before using any sterile equipment check that:

 the packaging is intact

 there are no obvious signs of packaging contamination
 the expiry date remains valid
 any sterility indicators are consistent with the process being completed successfully.

Decontamination of reusable non-invasive care equipment must be undertaken:

 between each use/between patients

 after blood and/or body fluid contamination
 at regular predefined intervals as part of an equipment cleaning protocol
 before inspection, servicing or repair.

If providing domiciliary care, equipment should be transported safely and decontaminated as above before
leaving the patient’s home.

Always adhere to Control of Substances Hazardous to Health (COSHH) risk assessments and
manufacturers’ guidance for use and decontamination of all care equipment.

 all reusable non-invasive care equipment must be decontaminated between patients/clients using either
approved detergent wipes or
detergent solution, in line with manufacturers’ instructions, before being stored clean and dry.
  decontamination protocols must include responsibility for; frequency of; and method of environmental
decontamination
 an equipment decontamination status certificate will be required if any item of equipment is being sent to a
third party, eg for inspection, servicing or repair
 guidance should be sought from the infection, prevention and control team prior to procuring, trialling or
lending any reusable non-invasive equipment
 medical devices and other care equipment must have evidence of planned preventative maintenance
programmes.

6. Safe management of the care environment

The care environment must be:

 visibly clean, free from non-essential items and equipment to facilitate effective cleaning
 well maintained, in a good state of repair and with adequate ventilation for the clinical specialty.

Always adhere to COSHH(Control of Substances Hazardous to Health) risk assessments for product use and
processes for decontamination of the care environment. Substances can be harmful if they are ingested, inhaled,
instilled, or absorbed through the skin

Routine cleaning

 the environment should be routinely cleaned in accordance with the National Cleaning Standards
 use of detergent wipes is acceptable for cleaning surfaces/frequently touched sites within the care area
 a fresh solution of general-purpose neutral detergent in warm water is recommended for routine cleaning.
This should be changed when dirty or when changing tasks
 routine disinfection of the environment is not recommended however, 1,000ppm available chlorine should
be used routinely on sanitary fittings
 staff groups should be aware of their environmental cleaning schedules for their area and clear on their
specific responsibilities
 cleaning protocols should include responsibility for, frequency of, and method of environmental
decontamination.
7. Safe management of linen

Healthcare laundry must be managed and segregated in accordance with national health policy guidlines.
Healthcare linen is categorised as:

 Clean linen – linen washed and ready to be used.

 Used (soiled and fouled) linen – used linen, irrespective of state, which on occasion may be contaminated
by blood or body fluids, and
 Infectious linen – linen that has been used by a patient who is known or suspected to be infectious.

Storage and handling of clean linen:

 Hand hygiene should be performed prior to handling clean linen.

 Clean linen should be removed from plastic bags before storage to prevent the growth of Bacillus cereus.
  Clean linen should be stored above floor level in a designated area, preferably an enclosed cupboard that is
clean, dry and cool.
 If clean linen is not stored in a cupboard, then the trolley used for storage must be designated for this
purpose and completely covered with an impervious covering/or door that is able to withstand
decontamination.
 Clean linen storage areas should be dedicated for the purpose and appropriately designed to prevent damage
to linen and to allow for the rotation of stocks.
 Clean linen should be physically separated from used/infectious linen when in storage and during transport.

Storage and handling of used (previously known as soiled/fouled linen) and infectious linen:

 Staff handling used and/or infectious linen must wear appropriate PPE (see section 1.4).
 Hand hygiene must be performed after handling used and/or infectious linen.
 Ensure a laundry receptacle is available as close as possible to the point of use for immediate linen deposit.
 Used items of linen should be removed one by one and placed in the used linen hamper/stream.
 do not:
o rinse, shake or sort linen on removal from beds/trolleys
o place used linen on the floor or any other surfaces eg a locker/table top
o re-handle used linen once bagged
o overfill laundry receptacles (not more than 2/3 full); or
o place inappropriate items in the laundry receptacle eg used equipment/needles
 Infectious linen must not be sorted but should be rolled together and sealed in a water-soluble bag (entirely
water soluble ‘alginate’ bag or impermeable bag with soluble seams), which is then placed in an
impermeable bag immediately on removal from the bed and secured before leaving a clinical area.
 Linen should be placed in an impermeable bag immediately on removal from the bed or before leaving a
clinical department
 Linen bags/receptacles must be tagged (eg, hospital ward/care area) and dated
 Store all used/infectious linen in a designated, safe, lockable area while awaiting collection. Collection
schedules must be acceptable to the care area and there should be no build-up of linen receptacles
 All linen that is deemed unfit for re-use, eg, torn or heavily contaminated, should be categorized at the point
of use and returned to the laundry for assessment and disposal.

Linen used during patient transfer, eg, blankets, should be categorized at the point of destination.

Linen from patients infected with, or at high risk of having, Hazard Group 4 organisms (haemorrhagic fever viruses
such as Lassa Fever) should be disposed of at the point of use as Category A waste and must not be returned to a
laundry.

Benefits of water-soluble bags

 Reduce cross-contamination

Water soluble bags dissolve completely in water, leaving no residue behind. This reduces the risk of bacteria and
viruses being spread.

 Safe for septic systems

Water soluble bags are safe for septic systems because they dissolve in water and don't clog pipes.

 Environmentally friendly

Many water soluble bags are made from biodegradable materials that break down quickly in the wash.

 Minimize direct handling

Water soluble bags allow healthcare workers to bag soiled linen without having to directly handle it.

8. Safe management of blood and body fluid spillages

 Spillages of blood and other body fluids may transmit blood borne viruses.
 Spillages must be treated immediately by staff trained to undertake this safely.
 Responsibilities for the management of blood/body fluid spills must be clear within each area/care setting.
 If an organization locally approves a product for use in the management of blood and body fluid spills, the
organization is responsible for ensuring safe systems of work, including the completion of a risk assessment
approved through local governance procedures. Organization’s must confirm the efficacy and suitability of
the product (i.e., that it conforms with the relevant standards and is appropriate for the intended use) with
the product manufacturer.
 Healthcare providers should ensure that any polymer gel for non-patient use (eg spill kits, controlled drug
destruction, use by cleaning staff) is kept secure and away from patients

9. Safe disposal of waste (including sharps)

National health laws contain the regulatory waste management guidance for all health and care settings including
waste classification, segregation, storage, packaging, transport, treatment and disposal.
Health and Safety (Sharp Instruments in Healthcare) Regulations outline the regulatory requirements for employers
and contractors in the healthcare sector in relation to the safe disposal of sharps.

Definitions
Healthcare (including clinical) waste:
Clinical waste means waste from a healthcare activity (including veterinary healthcare) that:
 contains viable micro-organisms or their toxins which are known or reliably believed to cause disease in
humans or other living organisms. For example, if a patient is known or suspected to be infected, or
colonised, by an infectious agent. Clinical judgement should be applied in the assessment of waste and
should consider the infection status of a patient and the item of waste produced.
 contains or is contaminated with a medicine that contains a biologically active pharmaceutical agent, or
 is a sharp, or a body fluid or other biological material (including human and animal tissue) containing or
contaminated with a dangerous substance within the meaning of Regulation (EC) No 1272/2008 of the
European Parliament and of the Council on classification, labelling and packaging of substances and
mixtures, as amended from time to time.
Offensive waste is waste that:
  is not clinical waste,
 is not infectious, but may contains body fluids, secretions or excretions,
 is non-hazardous, and
 falls within waste codes 18 01 04 if from healthcare, or 20 01 99 if from municipal sources.
Table 1: Categories of waste and segregation at source

Category Segregation Treatment/disposal

Yellow bag with black stripe (tiger) Energy from waste, landfil
Offensive (non-infectious) bag permitted processes

UN approved orange bag, UN

Clinical waste (infectious only) approved box or sharps container For alternative treatment

Healthcare waste contaminated with non- UN approved yellow bag, UN For incineration or other p
hazardous pharmaceuticals or chemicals) approved box or sharps container process

Waste contaminated with cytotoxic or cytostatic UN approved purple bag, UN

medication approved box or sharps container For incineration

For incineration or other p

Non-hazardous pharmaceuticals (no sharps) Blue box/container process

Anatomical waste/full blood bag and blood

preserves UN approved red lidded container For incineration only

Energy from waste, recove

Domestic Black/clear bags landfill

Recycling Clear, green or other colour bag Recycling

Color Coding for Medical Waste Containers

Safe waste disposal at care area level:
Always dispose of waste:
 immediately and as close to the point of use as possible; and
 into the correct segregated colour coded rigid container or sharps box if a sharp
 Liquid waste, eg, suction canisters, must be rendered safe by adding a polymer gel or compound to the
container prior to placing in an orange lidded leak proof bin or yellow lidded leak proof bin if contaminated
by pharmaceuticals.
 waste bags must be no more than 2/3 full and no more than the UN approved weight and must be securely
tied using a plastic tie or secure knot using a ‘swan neck’ to close. Waste must be traceable back to
ward/care area or department, this may be achieved by writing on bags (prior to use), attaching sticky labels
or uniquely numbered tags with the post code on them.
 store all waste in a designated, safe, lockable area while awaiting collection. Collection schedules must be
acceptable to the care area and there should be no build-up of waste receptacles.
 Local guidance on management of waste at care level, eg, domiciliary settings should be followed.
Sharps containers
Sharps containers must:
 have a handle (small community boxes do not require a handle) and temporary closure mechanism,
employed when box is not in use
 be disposed of when the manufacturers’ fill line is reached
 be labelled with point of origin and date of assembly and disposal. Where re-usable sharps containers are
used, organization’s must have a protocol in place to assure themselves of safe use and reprocessing.
 
10. Occupational safety: prevention of exposure (including sharps injuries)
The Health and Safety (Sharp Instruments in Healthcare) Regulations 2013 outline the regulatory requirements for
employers and contractors in the healthcare sector in relation to: arrangements for the safe use and disposal of
sharps; provision of information and training to employees; investigations and actions required in response to work
related sharps injuries.
There is a potential risk of transmission of a BBV (blood bourne virus) from a significant occupational exposure
and staff must understand the actions they should take when a significant occupational exposure incident takes
place. There is a legal requirement to report all sharps injuries and near misses to line managers/employers.
A significant occupational exposure is:
 a percutaneous injury eg injuries from needles, instruments, bone fragments, or bites which break the skin;
and/or
 exposure of broken skin (abrasions, cuts, eczema, etc); and/or
 exposure of mucous membranes including the eye from splashing of blood or other high risk body fluids.
For the management of an occupational exposure incident see Appendix 10.

Safety devices
Health and Safety (Sharp Instruments in Healthcare) Regulations 2013 are concerned with reducing and eliminating
the number of ‘sharps’ related injuries which occur within healthcare. Its basic guidance is:
 avoid unnecessary use of sharps
 if use of medical sharps cannot be avoided, source and use a ‘safer sharp’ device;
 if a safer sharp device is not available then safe procedures for working with and disposal must be in place
eg sticky mats, sharps bins, safety procedures and training.
Sharps handling must be assessed, kept to a minimum and eliminated, if possible, with the use of approved safety
devices.
 manufacturers’ instructions for safe use and disposal must be followed
 needles must not be re-sheathed/recapped or disassembled after use
 sharps must not be passed directly hand to hand
 used sharps must be discarded at the point of use by the person generating the waste
 always dispose of needles and syringes as 1 unit
 if a safety device is being used safety mechanisms must be deployed before disposal.
When transporting sharps boxes for community use these must be transported safely with the use of temporary
closures.
Energy from waste, landfill or other permitted processes Clinical waste (infectious only) UN approved orange bag, UN
approved box or sharps container For alternative treatmen

For incineration or other permitted process