Infection Control Annual Statement

Purpose

This Annual statement has been drawn up on 23rd Decemeber 2025   in accordance with the requirement of the Health and Social Care Act 2008: code of practice on the prevention and control of infections and related guidance for Eastfield House Surgery.  It summarises:

1. Infection transmission incidents and actions taken 
2. IPC audits undertaken and subsequent actions implemented
3. Risk assessments undertaken and any actions taken for prevention and control of infection 
4. Staff training 
5. Review and update of IPC policies, procedures and guidelines
6. Antimicrobial prescribing and stewardship

This statement has been drawn up by:

Hollie Webb
Infection Prevent and Control (IPC) Lead 

1. Infection transmission incidents

Of the five patients reviewed for Clostridioides difficile this year, one patient is deceased, one is no longer registered with the practice, and one case was hospital-acquired.

The fourth patient was prescribed cefalexin for the treatment of a urinary tract infection following unresolved symptoms despite previous antibiotic therapy. The patient was re-advised regarding potential side effects, and a stool sample was requested at the onset of diarrhoeal symptoms. To further improve patient care, a urine sample could have been obtained at an earlier stage to support the selection of the most appropriate antibiotic therapy.

There was a delay in requesting a stool sample for the final patient. This patient presented with multiple risk factors, including recent hospital attendance for gastrointestinal investigations, advanced age, recent antibiotic use, and proton pump inhibitor therapy for Helicobacter pylori eradication.

All clinicians have been reminded of current guidance regarding the management of C. difficile, including assessment of risk factors, appropriate sample requests and treatment protocols.

2. IPC Audits and actions 

Annual and quarterly audits relating to infection prevention & control are completed, and any areas highlighted for improvement are acted on promptly to ensure the safety of staff and service users. Audits completed include:

• Environmental Cleanliness (monthly-3 monthly)
• Hand hygiene (6 monthly)
• Aseptic non-touch technique ( Annually)
• IP&C audit and efficacy checklist.(Annually)
• Personal Protective Equipment (6 monthly)
• Care of equipment. (Monthly)
• Sharps audit (Annually)
• Audit of care environment (Annually)
• Vaccine management Audit ( Annually)
• Waste Audit (Annually)

Over the past year, the practice has worked closely with daily cleaning staff and the managers at ServiceMaster to ensure that cleaning tasks are performed to a consistently high standard. Dusting of high areas has been identified as a recurring area of concern. These areas are subject to regular audits and reviews by both practice staff and ServiceMaster personnel to ensure compliance with cleaning protocols and to maintain a safe and hygienic clinical environment.

During the reporting year, the practice implemented the use of a light box as part of hand hygiene training to visually demonstrate areas of the hands that are commonly missed during hand washing. This intervention proved effective in raising staff awareness of hand hygiene technique and supporting improved compliance with infection prevention and control standards.

3. Risk Assessments 

Risk assessments are carried out to ensure best practice is being followed and minimise the risk of infection, to ensure the safety of patients and staff. We continue to work closely with ServiceMaster, to which high standards are maintained and regular inspections carried out

• Legionella risk assessment
• Taps risk assessment
• Risk assessment for reception including handling samples.

The hand wash basins in clinical rooms are not compliant with infection control requirements. Whilst plans are in place for the new surgery to be built with compliant sinks, changing the sinks in the surgery would be a large undertaking, practically and financially now. The sinks are not wall-mounted, lack mixer taps, and include overflow pipes. To mitigate the risk of infection, staff are reminded to ensure that countertops surrounding sinks are kept free of clutter and that the edges of the sink are cleaned with a Clinell wipe after hand washing.  

As of this year, the practice has commenced the acceptance of stool samples for testing. Reception staff must not handle specimen pots directly. All samples are required to be placed into a disposable clear specimen bag by the patient. Reception staff must undertake appropriate hand hygiene following contact with specimen bags.

4. Staff training 

Eight new staff joined Eastfield House Surgery in the past 12-months and received infection control training within 2 months of employment. 

86.1% of the practice patient-facing staff (clinical and reception staff) completed their online annual infection prevention & control update training. 

100% of the practice non-patient-facing staff completed their 3-yearly infection prevention & control update training.

The IPC nurse attended training updates for their role. Training is provided by the BOB ICB Webinars.

5. IPC Policies, procedures and guidance

Documents related to Infection Prevention and Control are reviewed in line with national and local guidance and are updated biennially, or sooner if new guidance is issued. New policies and changes implemented within the practice include:

• Following water damage to the carpets in the main reception area, a decision was made to replace the carpet with hard flooring. This surface is easier to clean and maintain, allowing effective management of spills and a reduction in contamination risk.
• West Berkshire Council introduced a weekly food waste collection service. All food waste generated within the practice is collected in a designated caddy in the staff kitchen for appropriate disposal.
• The practice is now accepting stool samples in line with current guidance.

6. Antimicrobial prescribing and stewardship

The practice actively promotes responsible antimicrobial prescribing and stewardship in line with national and local guidance. Prescribing is regularly audited, and results are reviewed at clinical meetings to identify opportunities for improvement. All antibiotic prescriptions are documented with clear indications, dose, and duration, and are reviewed considering diagnostic results where appropriate. Staff receive ongoing training on antimicrobial stewardship, including updates from local antimicrobial guidance (SCAN) and UKHSA resources, and learning from significant events is shared across the team. Patients are supported through education on appropriate antibiotic use, self-care advice, and safety-netting for common infections. The practice also follows guidance on timely collection of diagnostic samples to inform treatment decisions. These measures ensure that antibiotic prescribing is safe, evidence-based, and in line with best practice.

Patients are encouraged to use the alcohol hand gel/sanitiser dispensers that are available throughout the Surgery. Masks are available to patients who wish to use them. Masks are highly encouraged for patients who have respiratory symptoms including cough, cold or flu-like.

Forward plan/Quality improvement plan review date: December 2026