Practitioners should be registered with a professional body. There are two UK bodies: the British Acupuncture Council (BAcC) and the British Medical Acupuncture Society (BMAS). Members of BAcC are registered practitioners who have undertaken at least three years' full time training in acupuncture. Members of the BMAS are medical practitioners with an interest in acupuncture.

Acupuncture is not generally available on the NHS but some GPs have a contract with a local acupuncturist and may make a referral.

All acupuncturists should observe a code of practice that covers standards of hygiene and sterilisation for needles and equipment used. An example of such a code of practice is that with which BAcC members have to comply.  www.acupuncture.org.uk

The BAcC code defines the minimum standards required for safe practice and states that practitioners must comply to Local Authority bylaws where the individual practises. Information on local bylaws relating to acupuncture is available from Environmental Health Departments. For example: www.aylesburyvaledc.gov.uk/business/licensing/body_art.htm Such bylaws cover:

• premises
• equipment
• clean hygienic procedure
• disposal of equipment and clinical waste
• mobile acupuncturists and home visits
• register of patients and patient records
• health and safety at work.

Body piercing and tattooing carry an inherent risk of acquiring a blood-borne infection through lapses in infection control practices. Whilst outbreaks of hepatitis B, hepatitis C infection have been recorded, cross infection of common bacterial infections is more likely. However, this can become a rare occurrence if infection prevention and control practices are adhered to¹.

In England and Wales, the Local Government Act 2003² covers cosmetic piercing and skin-colouring businesses. This act requires that such businesses:

• register themselves and their premises
• observe byelaws relating to the cleanliness and hygiene of premises, practitioners and equipment.

In Scotland, guidance is available from SCIEH³ for Local Authorities on body and skin piercing.

HABIA, a Government recognised standards setting body, is currently undertaking a consultation process to develop National Occupational Standards for the hair, beauty and body art industry. www.habia.org.uk

The types of childcare facilities available include:

• day nurseries
• child minders
• playgroups, pre-schools and crèches
• out-of-school clubs
• family centres
• schools.

The factors that may influence the spread of infections in schools and other childcare facilities include:

• prevalence of the infectious agent in the population
• number of susceptible children present
• age of the children
• hygiene practices of staff
• amount of close contact between children
• sharing of facilities and types of equipment
• natural curiosity of children
• presence of bites and abrasions
• incomplete immunisations.

As environmental factors can affect the spread of infections, there are regulations and guidelines about the facilities needed for reasons of health and safety¹². www.dh.gov.uk/PublicationsAndStatistics/. For example, nurseries should provide separate rooms for children under the age of two years to rest, sleep and play.

Other recommendations include:

• sufficient toilets of child sizes, with flushing systems and toilet lids or step and child toilet seats
• dedicated nappy changing area
• hand washing facilities
• purchase of easily cleaned furniture and fittings
• written cleaning schedules for the environment, toys and equipment.

Good hygiene practices apply to everybody and should be practised every day to prevent the spread of infection. Standard infection control precautions within all childcare facilities include:

• hand washing
• use of protective clothing
• general cleaning
• changing mats/nappy changing areas
• furniture
• toilet areas
• waste and laundry
• female hygiene
• spillages
• exclusion of children with an infection
• play and equipment
• feeding bottles/teething aids
• sand/water/playdough
• sensory equipment
• food hygiene
• pets/farm visits/zoo visits.

All practitioners providing complementary healthcare should be registered with an appropriate organisation that makes sure its members are properly qualified, insured to practice, and that they undertake continuing professional development. The Nursing and Midwifery Council (NMC) recognises that some practitioners have acquired qualifications in complementary therapies and wish to incorporate these skills into their practice. However, the NMC does not regulate the standards of other bodies that provide education and training in complementary therapies. It is the responsibility of the individual practitioner to judge if the qualification gained has provided him/her with a level of competence to use his/her skill with his/her patients⁴.

Employers should develop local policies for the use of complementary therapies by practitioners in their employment. These policies should include:

• training
• risk assessment
• reporting of critical incidents
• disposal of equipment
• storage of equipment and essential oils
• spillages of essential oils.

The Department of Health has published the ‘essential steps to safe, clean care’. This is a delivery programme which aims to reduce healthcare associated infections, including MRSA. The ‘essential steps’ programme provides tools and guidance to support different organisations and settings, including independent healthcare facilities, as they work towards reducing and eradicating healthcare associated infections. Click here for more information on the ‘essential steps’ programme

Approximately two thirds of deaths happen in hospitals. Advice on managing the hazards associated with the deceased utilises a risk assessment approach based on the Health and Safety at Work Act 1974⁶, Control of Substances Hazardous to Health (COSHH) 2004⁷ and safety guidelines for laboratories and post-mortem rooms⁸.

Environmental health departments have statutory duties for cemeteries and crematoriums and are often responsible for health and safety at funeral premises.

Education on the use of appropriate protective clothing and hygienic practices will ensure safe working conditions when handling most cadavers. Not all notifiable diseases or all pathogenic micro-organisms carry an equal risk of infection to funeral directors⁹. Good communication will enable funeral directors to assess the risks to themselves and their staff, and enable decisions to be made on embalming and on how the deceased is presented to relatives.

Sources of infection include:

• blood and body fluids
• direct skin contact
• clinical waste
• sharps injuries
• soil (exhumation).

Conditions and pathogens that present particular risks include:

• tuberculosis
• group A streptococcal infection
• gastrointestinal organisms
• Creutzfeldt-Jakob disease
• hepatitis B and C viruses
• HIV
• meningitis and septicaemia (especially meningococcal).

Safe systems of practice include:

• use of appropriate protective clothing
• wearing gloves for handling hazardous material and handling bodies
• wearing chemically protective gloves over examination gloves to protect from longer term exposure to chemical hazards such as formaldehyde
• respiratory protection – filter masks
• splash protection – visor, apron and rubber boots
• whole body protection – gowns/coats.

The risk of infection for patients attending GP surgeries is due to the large numbers of people using the facilities, sharing equipment and the contact between each other and healthcare workers¹⁰.

The increase in investigations and invasive procedures, including minor surgery, adds to the risk of cross infection. Attention to decontamination of medical devices is even more important with the emergence of variant Creutzfeldt-Jakob Disease (vCJD), and viruses such as hepatitis B and C and HIV¹¹.

Primary care is subject to the same infection control regulations as other parts of the health service. General practitioners have a statutory duty under the Health and Safety at Work Act 1974⁶ to create a safe environment. Infection prevention and control is an important part of safety in healthcare settings and includes:

• written infection control policies
• hand hygiene
• protective clothing and equipment
• laundry management
• sharps management
• waste management
• environmental cleaning
• exposure to blood or body fluids
• training and education in infection control for all staff
• audit of clinical practices to check compliance with existing policies
• practice design
• a designated procedure room
• patient preparation and recovery area
• separate facilities for equipment/instrument decontamination and reprocessing
• planning of multi-use rooms
• decontamination of equipment
• risk assessment to choose appropriate method
• accurate record keeping and traceability of instruments and processes used
• separate sink for hand hygiene
• handling and transportation of specimens.

The Department of Health has published the ‘essential steps to safe, clean care’. This is a delivery programme which aims to reduce healthcare associated infections, including MRSA. The ‘essential steps’ programme provides tools and guidance to support different organisations and settings, including GP surgeries and other primary care facilities, as they work towards reducing and eradicating healthcare associated infections. Click here for more information on the ‘essential steps’ programme.

As with GP surgeries, health centres should have policies and procedures in place to ensure a safe environment for patients and staff. Within a health centre there is a wide range of patient services which can include:

• podiatry
• physiotherapy
• family planning clinics
• leg ulcer clinics
• dentistry
• pharmacy
• well women clinics
• vaccination clinics.

Design is an important element in preventing cross infection, and careful planning and room management is required to ensure this. A risk assessment should be undertaken before clinics are assigned to the rooms that are available, taking into account the available facilities, such as hand washbasins. It is also important that there is a differentiation made between clinical rooms and office/storage space. Access to the Sterile Services Department or separate facilities for decontaminating equipment should be available.

See GP surgeries for advice on best practice and protocols required.

NHS Estates document on infection control in the built environment www.nhsestates.gov.uk

The Department of Health has published the ‘essential steps to safe, clean care’. This is a delivery programme which aims to reduce healthcare associated infections, including MRSA. The ‘essential steps’ programme provides tools and guidance to support different organisations and settings, including Health centres and other primary care facilities, as they work towards reducing and eradicating healthcare associated infections. Click here for more information on the ‘essential steps’ programme.

Most people living in residential and nursing homes are elderly and are vulnerable to acquiring infection due to the aging process, their difficulty in maintaining personal hygiene and any underlying chronic condition and/or disease.

The environment in which residents are cared for and live is non-clinical and as near to a home as can be achieved safely. Consideration needs to be given to:

• floors and surfaces
• soft furnishings
• bathrooms and showers
• toilets
• commodes
• sluices
• laundry rooms
• catering facilities.

Standard infection control precautions should be taken with all residents in all situations. The key principles include:

• effective hand decontamination
• sharps management
• waste management
• use of personal protective equipment
• management of spillages
• decontamination of equipment.

National minimum standards for care homes in England can be found on the Commission for Social Care Inspection web site.

The Department of Health has published a guidance document on infection control within care homes. Click here for further information.

The Department of Health has published the ‘essential steps to safe, clean care’. This is a delivery programme which aims to reduce healthcare associated infections, including MRSA. The ‘essential steps’ programme provides tools and guidance to support different organisations and settings, including residential and nursing homes, as they work towards reducing and eradicating healthcare associated infections. Click here for more information on the ‘essential steps’ programme.