Control of infection in general practice: a survey and recommendations

Decontamination of reusable instruments in primary care

Staff who undertake effective decontamination in non-centralized settings such as general practices must be provided with training and easy-to-follow guidance. In this article we present a distillation of the current guidance in an industrial quality control format of fishbone charts. A fishbone chart (or cause-and-effect chart) depicts all the causes of an outcome in a logical way to facilitate the identification of a specific problem. We developed our fishbone chart to include instructions that, if followed, would achieve safe and effective cleaning and sterilization. A survey of those given the charts showed high user acceptability: 76% found the fishbone better than existing guidelines - although the response rate was low at 46%. The charts will enable those involved in decontamination of instruments, including managers and infection control staff, to audit the facilities, equipment and practices. The use of industrial quality tools may assist other specialties that require complicated and comprehensive guidelines to be presented in a more user-friendly design.

Autoclave performance and operator knowledge of autoclave use in primary care: a survey of UK practices

Changes in the delivery of health care have increased the demand for minor surgical and screening procedures in general practice. This has increased the risk of cross-infection with blood-borne viruses and the demand for sterile instruments. The aim of this study was to investigate the knowledge and training of medical personnel in England and Wales on aspects of autoclave use, and to test the effectiveness of their practice autoclaves. An anonymous postal questionnaire and autoclave performance survey using biological indicators was made of 700 general medical practitioners selected at random from FHSA lists from 12 Health Authorities in England and Wales. The overall response rate was 53.1% (N= 372) comprising 10% general practitioners and 90% practice nurses. Eighty-two percent of respondents used autoclaves with a mean age of 2.5 years, of which 91% had been serviced in the past year. While 35% of respondents made daily observation of gauges, 19% did not routinely monitor autoclave effectiveness. Six autoclaves failed to sterilize the spore test ampoules. Fourteen percent of respondents did not autoclave instruments after every patient. Only 33.1% reported wearing gloves during minor operations. Fifty five percent had training in cross-infection prevention. It was concluded that although there has been improvement in instrument decontamination procedures in general practice compared with previous surveys, further education of medical practitioners and practice nurses in the use of autoclaves and infection prevention and control is indicated. The failure of 2% of the autoclaves to kill spores suggests the need for increased monitoring of autoclave performance. Two-thirds of practitioners exposed themselves to increased risk of infection by carrying out minor surgery without the protection of gloves.

Improving infection control in general practice

Infection control measures in the health care setting should protect patients and staff from cross-infection. The prevention of harm is an essential part of good medical practice and failure might result in professional misconduct proceedings by the General Medical Council (GMC) and prosecution under the Health and Safety at Work legislation, as well as civil liability. For a health authority, overall responsibility for public health includes arrangements for the control of communicable diseases and infection in hospital and the community (NHS Management Executive, 1993), a function usually led by the Consultant in Communicable Disease Control (CCDC). This paper describes one district's collaborative approach between public health and GPs to assess and improve local infection control standards.

Sterilization of instruments in general practice: what does it entail?

There is increasing interest amongst general practitioners in carrying out minor surgical procedures but it is unclear what resources are available for this. We decided to assess the level of knowledge of sterilization and the use of benchtop sterilisers in general practice by circulating a postal questionnaire to the 883 general practices in the Trent Regional Health Authority. The response rate was 49%. Minor surgical procedures were performed in 86% of practices but less than half of respondents understood what was meant by sterilization, 28% considered that the floor of the surgery should be disinfected or sterilised and 13% believed that immersion in 2% glutaraldehyde for 10 min constituted sterilization. 93% had a benchtop steriliser, only a quarter kept a log book, and approximately a third had it serviced at intervals of one year or longer. Less than 50% understood the correct position in which a bowl or kidney dish should be placed and 41% had used or had access to a local sterile services department. The concept of sterilization is not clearly understood and the use of benchtop sterilisers in Trent is suboptimal. On-going education of staff in primary care is required and consideration should be given to a system of accreditation.

Infection control in GP surgeries: safe practices?

Any increase in the use of invasive procedures carries with it an increased risk of cross-infection. The spread of the human immunodeficiency virus, together with increasing awareness of hepatitis B virus, cytomegalovirus and human papillomavirus have focused attention on the nature and adequacy of procedures to prevent cross-infection in general practice.

Neonatal cross-infection with Listeria monocytogenes

Transmission of Listeria monocytogenes by food continues to cause concern. Even so, this is not the only means of transmission and neonatal hospital-acquired infection has been well recorded. We report here two cases of perinatal listeriosis one of which was likely to have been due to cross-contamination in a Special Care Baby Unit (SCBU) with equipment acting as the vehicle.

Sterilization and disinfection in the physician's office

OBJECTIVE

To review the principles and practice of sterilization and disinfection of medical instruments in the office setting.

DATA SOURCES

Searches of MEDLINE for articles published from 1980 to 1990 on disinfection, sterilization, cross infection, surgical instruments and iatrogenic disease, bibliographies, standard texts and reference material located in a central processing department.

STUDY SELECTION

We reviewed surveys of decontamination practices in physicians' offices, reviews of current recommendations for office decontamination procedures, case reports of cross infection in offices and much of the standard reference material on decontamination theory and practice.

DATA SYNTHESIS

There have been few surveys of physicians' decontamination practices and few case reports of cross infection. Office practitioners have little access to practical information on sterilization and disinfection.

CONCLUSION

The increasing threat of cross infection from medical instruments calls for greater knowledge about decontamination. We have adapted material from various sources and offer a primer on the subject.

Infection control procedures among New Zealand general practitioners: changes since the emergence of HIV infection

A random sample of 1000 general practitioners in New Zealand were surveyed to assess their infection control procedures in the surgery, particularly since the emergence of the human immunodeficiency virus (HIV). Forty three per cent of the sample routinely used surgical gloves for minor surgical procedures, 8% used gloves for venepuncture, and 7% for blood glucose testing. Thirty two per cent reported a change in glove use since the emergence of HIV infection. Changes in sterilization procedures were also studied. Thirty eight per cent of the sample reported increased use of disposable equipment, and 38% reported changes in the sterilization solution used. Increased time spent by equipment in the sterilizer was reported by 33% of respondents and increased use of an autoclave by 18%. In general, women were more likely to have adopted infection control procedures than men. Infection control was also more common among those doctors having the greatest number of patients requesting HIV testing.