Methods of preventing infection transmission from person to person
- You must decontaminate your hands regularly and thoroughly to prevent the spread of infection, see paras B29-B31.153 You can reduce the risk of transmitting infections such as methicillin-resistant Staphylococcus aureus (MRSA) or Clostridium difficile (C.diff) if you use fastidious hand hygiene.
- There are a number of organisms present in healthy skin: some are resident organisms (skin commensals) and are mostly harmless, although some are known to cause mild eye infections. You can reduce the number of skin commensals left on your skin by washing with an antiseptic detergent preparation, instead of soap and water.
- Other transient organisms can be deposited on the skin, including certain gram-negative bacteria which could lead to more serious corneal infections. You can remove most of these transient organisms by thoroughly washing with liquid soap and water.
- You must decontaminate your hands, as appropriate:
- before every episode of direct patient contact or care
- after every episode of direct patient contact or care
- after any exposure to body fluids (including tears)
- after any other activity or contact with a patient’s surroundings that could potentially result in hands becoming contaminated, and
- after removal of gloves.
- You can use an antibacterial handrub between patients during a clinic session. Alcohol is not a cleaning agent so you should perform a proper handwash with soap and water at the beginning and completion of the clinic session, as well as after exposure to body fluids. Alternatively, you can wash your hands between patients.
- You should also decontaminate your hands:
- before (and after) contact lens insertion or removal
- after going to the toilet
- when hands are visibly dirty
- before (and after) contact with ocular surfaces and adnexae
- before (and after, if necessary) administering medication, for example eye drops, and
- after any possible microbial contamination, e.g. contact with body fluids, wounds, or clinical waste.
- You should use the following handwashing technique for most procedures you perform in the clinical setting:
- wet hands under running water
- dispense liquid soap or antiseptic into cupped hand (bar soap should not be used)
- rub hands vigorously and thoroughly for 10-15 seconds without adding more water
- ensure all surfaces of the hands are covered
- rinse hands thoroughly under warm running water, and
- dry hands with a disposable paper towel. You should not use non-disposable towels.
- Hand hygiene agents include:
- liquid soap
- antiseptic, and
- antibacterial (alcohol-based) handrubs.154
- Handwashing with soap and water is effective in removing most transient microorganisms and is usually all you need to prevent infection. In clinical areas, you should:
- use liquid soap in disposable containers or containers that are washed and dried before refilling, and
- never top up the containers.
- Antiseptic agents are effective in reducing both transient and resident microorganisms. Chlorhexidine (4%) preparations have a residual effect against transient organisms influencing the survival time on hand surfaces.155 You should use an antiseptic agent:
- before and after direct contact with patients in clinical settings, where there is an outbreak of antimicrobial resistant organisms (e.g. residential or nursing homes)
- where there is heavy microbial contamination, or
- before performing invasive procedures or minor operations.
- Antibacterial (alcohol-based) handrubs rapidly destroy microorganisms on the skin surface. However, they are not a cleaning agent and you should not use them if hands are visibly dirty or contaminated with blood, bodily fluids or other potentially infectious agents. They are especially useful in situations where handwashing and drying facilities are inadequate e.g. domiciliary visits, or between patient contacts.
- You should not use alcohol handrubs as a substitute for handwashing with soap and water, when these are available. You are strongly advised to wash your hands at the start and finish of a session. Alcohol handrubs are not effective against Clostridium difficile spores or norovirus (a cause of viral gastroenteritis) so you should use liquid soap and water in situations where there is potential for the spread of these organisms.
- The standard for efficacy of hygienic handrubs uses a reference of 60% isopropyl alcohol. However, to be effective against staphylococci, including MRSA, handrubs must contain 70% of either ethyl or isopropyl alcohol.
- If you use an unperfumed alcohol-based handrub prior to contact lens insertion it has been shown to have a negligible effect on ocular comfort, redness and lens wettability. You should ensure that the handrub has been allowed to dry on the hands as instructed by manufacturers (often 15 seconds).
Maintain the integrity of your skin
- To maintain the integrity of your skin, you should:
- cover cuts and abrasions to skin with waterproof dressings (preferably coloured)
- dry skin properly with paper hand towels after washing, and
- use hand cream as appropriate; you should not share jars of hand cream with others.
Keep up to date with immunisation
- You should keep up to date with immunisation, including:
- tuberculosis, and
- hepatitis B.
Minimise the risk of airborne infection
- You should minimise the risk of airborne infection by:156
- covering your nose and mouth and using a tissue whilst coughing or sneezing
- disposing of used tissues in the nearest receptacle as soon as possible157
- performing hand hygiene after coughing or sneezing
- not working in clinical practice if you have an acute upper respiratory tract infection, such as the common cold, and
- avoiding touching your mouth, eyes and nose unless you have performed hand hygiene.
- Wear protective clothing:
- to protect against direct contact with body fluid, or
- while handling and cleaning decontaminated equipment.
- You do not have to use a mask, unless there is a serious respiratory risk involved. Ordinary surgical masks are not effective protection. In these cases, you should wear specialised respiratory protection.158
- You should wear gloves where you consider there is a risk from:
- invasive procedures
- contact with:
- non-intact skin, or
- mucous membranes
- exposure to:
- bodily fluids, including tears
- sharp or contaminated instruments, or
- other contaminated material, for example dressings.
- You should consider the following factors when deciding to wear gloves:
- whether the patient has an overt infection, such as ulcerative blepharitis or acute viral or bacterial conjunctivitis
- the degree of contact with bodily fluids or infected tissue, and
- the consequences of infection.
- You do not have to wear gloves to:
- carry out a normal eye examination
- perform minor procedures where there is no likelihood of cross-inoculation with bodily fluids, or
- fit contact lenses.
- You should practise thorough hand hygiene before wearing, and after removing, gloves, as they may not provide complete protection.
- You can use non-sterile disposable examination gloves. However, if you undertake a procedure which requires a sterile environment you must use sterile surgical gloves. You must not use polythene gloves for clinical interventions. If you choose to use latex gloves you should be aware that these might cause allergic reactions such as asthma in sensitised individuals.159 160
Appropriate sharp disposal
- If you need to use sharps you should use and dispose of them safely by: 162
- using equipment with safety devices, and
- using safe handling and disposal procedures.
153 National Institute for Health and Care Excellence (2017) Healthcare-associated infections: prevention and control in primary and community care. Clinical Guideline 139 [Accessed 2 Nov 2017]
154 British Standards Institute (2013) Chemical disinfectants and antiseptics. Hygienic handrub. Test method and requirements (phase 2/step 2). BS EN 1500:2013 [College members can access British Standards Online via the College website] [Accessed 7 Nov 2017]
155 Chlorhexidine is known to induce hypersensitivity, including generalised allergic reactions and anaphylactic shock. The prevalence of chlorhexidine hypersensitivity is unknown but is likely to be very rare. For further information see MHRA (2012) Chlorhexidine: reminder of potential for hypersensitivity [Accessed 2 Nov 2017]
156 NHS Choices. Catch it, Bin it, Kill it [Accessed 7 Nov 2017]
157 Department of Health and the Health Protection Agency in collaboration with the Chartered Institute of Environmental Health (2008) Pandemic flu. Guidance for environmental health practitioners [Accessed 2 Nov 2017]
158 Pratt RJ, Pellowe CM, Wilson JA et al (2007) Epic2: National Evidence-Based Guidelines for Preventing Healthcare-Associated Infections in NHS Hospitals in England. Journal of Hospital Infection 65(S1) S1-S61, but see page S22
159 NHS Plus, Royal College of Physicians, Faculty of Occupational Medicine (2008) Latex allergy: occupational aspects of management. A national guideline [Accessed 2 Nov 2017]
160 Health and Safety Executive. Latex allergies [Accessed 2 Nov 2017]
161 The Health and Safety (Sharp Instruments in Healthcare) Regulations SI 645 of 2013 [Accessed 2 Nov 2017].
162 Health and Safety Executive (2013) Health and Safety (Sharp Instruments in Healthcare) Regulations 2013: Guidance for employers and employees [Accessed 2 Nov 2017]